Podcasts about Canadian Medical Association Journal

A new study published in the Canadian Medical Association Journal suggests that long wait times for hip and knee replacement surgeries in Canada — affecting about one in three patients — could be significantly reduced by implementing a centralized, team-based referral system instead of turning to private clinics. Guest: Dr. David Urbich - Study Author and Head of the Department of Surgery at Women's College Hospital in Toronto Learn more about your ad choices. Visit megaphone.fm/adchoices

In parts 1 and 2 we looked into a 2018 journal article called Management of osteoarthritis of the knee in younger patients by Khan, Adili, Winemaker, and Bhandari. It turns out we aren't the only ones looking into it. As I was finishing up this piece, I was googling to make sure I had a list of all the links I used in the piece (while I don't include links to pieces with weight stigma here, I always keep a list in my draft,) I stumbled onto a letter responding to the Khan et al. article called “Is it weight loss or exercise that matters in osteoarthritis?” by Ilona Hale, MD, published in the Canadian Medical Association Journal, which is the same journal that published the Khan et al. article. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Le pamplemousse est un fruit aux multiples bienfaits, riche en vitamine C et en antioxydants. Pourtant, il peut devenir dangereux lorsqu'il est consommé avec certains médicaments. Ce phénomène est bien documenté en pharmacologie et repose sur son interaction avec une enzyme clé du métabolisme des médicaments.Un effet sur le métabolisme des médicamentsLe principal problème du pamplemousse vient de sa capacité à inhiber une enzyme du foie et de l'intestin, appelée cytochrome P450 3A4 (CYP3A4). Cette enzyme joue un rôle majeur dans la dégradation de nombreux médicaments avant leur passage dans la circulation sanguine. En bloquant son action, le pamplemousse empêche le métabolisme normal de ces substances, ce qui peut entraîner une accumulation excessive du médicament dans l'organisme et augmenter le risque d'effets secondaires graves.Quels médicaments sont concernés ?De nombreuses classes de médicaments sont affectées, notamment :- Les statines (anti-cholestérol) : Une étude publiée dans The American Journal of Medicine (1998) a montré que la consommation de jus de pamplemousse pouvait augmenter jusqu'à 15 fois la concentration de certaines statines (simvastatine, atorvastatine). Cela accroît le risque d'effets secondaires comme des douleurs musculaires, voire des atteintes musculaires sévères (rhabdomyolyse).- Les antihypertenseurs : Une recherche menée en 2012 dans The Canadian Medical Association Journal a démontré que le pamplemousse augmentait la concentration de certains inhibiteurs calciques (comme l'amlodipine et le félodipine), entraînant une chute excessive de la pression artérielle et des risques de vertiges ou de syncope.- Les immunosuppresseurs (utilisés après une greffe) et certains anxiolytiques (comme le triazolam) sont également impactés, avec un risque de toxicité accru.Combien de temps dure l'effet du pamplemousse ?L'effet inhibiteur du pamplemousse sur le CYP3A4 peut durer jusqu'à 72 heures après ingestion. Cela signifie qu'il ne suffit pas d'espacer la prise du médicament et la consommation du fruit ; il est préférable de l'éviter complètement si votre traitement est concerné.ConclusionLe pamplemousse peut perturber le métabolisme de nombreux médicaments en augmentant leur concentration sanguine, ce qui accroît les effets secondaires et la toxicité. Il est donc essentiel de lire les notices et de demander conseil à un professionnel de santé avant de consommer ce fruit si vous prenez un traitement. Hébergé par Acast. Visitez acast.com/privacy pour plus d'informations.

Join Drs. Stephanie Hartman and Abby Drucker as they discuss the history of medical quackery, pseudoscience and current challenges in today's medical practice with Dr. Lydia Kang. Dr. Kang is an author of young adult fiction, adult fiction and non-fiction, and poetry. She is a practicing physician and Associate Professor of Internal Medicine at Nebraska Medicine who has gained a reputation for helping fellow writers achieve medical accuracy in fiction. Her poetry and non-fiction have been published in JAMA, The Annals of Internal Medicine, Canadian Medical Association Journal, Journal of General Internal Medicine,. The Linden Review, and Flatwater Free Press. She is the co-author of Quackery: A Brief History of the Worst Ways to Cure Everything and the upcoming book, Pseudoscience: An Amusing History of Crackpot Ideas and Why We Love Them.  You can find Dr. Kang at  LydiaKang.com BlueSky: @lydiakang.bsky.social IG: @LydiaKang We invite you to pre-order Pseudoscience: An Amusing History of Crackpot Ideas and Why We Love Them at The Bookworm Omaha. We rely on your donations to keep producing this podcast content and to support physician advocacy in Nebraska. If you would like to support Nebraska Alliance for Physician Advocacy, a 501(c)(3) organization in Nebraska please click to DONATE NOW.  If you have questions or answers, please email us at ⁠contact@nebraskaallianceforphysicianadvocacy.org⁠ Please check out our website at: Nebraska Alliance for Physician Advocacy Instagram Link https://www.instagram.com/neallianceforphysicianadvocacy/ Facebook https://www.facebook.com/neallianceforphysicianadvocacy

In this episode of The Brave Enough Show, Dr. Sasha Shillcutt and Dr. Lydia Kang discuss: Dr. Lydia Kang's journey as an author and how she balances her writing with her work as a physician. They talk about how to receive negative feedback and how rejection can be a stepping stool to deep growth. In this episode, they touch on:  How to filter feedback to assure it is useful to you  How to craft criticism in a way that people respond and grow from it  The beauty of sharing your rejections and failures with another person     “When you put yourself in big places and try bigger things, you are going to experience more failure and rejection. It is normal and more common that people understand in our shiny world of posting all the positive things on social media.” Dr. Lydia Kang    Dr. Lydia Kang is an author of young adult fiction, adult fiction and non-fiction, and poetry. She graduated from Columbia University and New York University School of Medicine, completing her residency and chief residency at Bellevue Hospital in New York City. She is a practicing physician and associate professor of Internal Medicine who has gained a reputation for helping fellow writers achieve medical accuracy in fiction. Her poetry and non-fiction have been published in JAMA, The Annals of Internal Medicine, Canadian Medical Association Journal, Journal of General Internal Medicine, and Great Weather for Media. She believes in science and knocking on wood, and currently lives in Omaha with her husband and three children.    Follow Dr. Lydia Kang Instagram  Website  facebook  Books    Episode Links:  REVIVE Retreat Brave Ballance   Follow Brave Enough:   WEBSITE | INSTAGRAM | FACEBOOK | TWITTER | LINKEDIN Join The Table, Brave Enough's community. The ONLY professional membership group that meets both the professional and personal needs of high-achieving women.

The guideline is published in the Canadian Medical Association Journal. The lead author on this updated is Igor Yakovenko. He is an associate professor in the Department of Psychology and Neuroscience and the Department of Psychiatry at Dalhousie University, where he studies addictive behaviours. Mainstreet's Alex Guye. To hear more about the update and what changes were made to its recommendations, Alex Guye gave professor Yakovenko a call. Here's part of their conversation.

THE MEDICAL RECORD PANEL: ONTARIO LAUNCHING A NURSING PROGRAM & CANCER PATIENTS IN THE ER  Libby Znaimer is joined by Dr. Fahad Razak,  General Internist at Unity Health Toronto and Canada Research Chair in Healthcare Data and Analytics at the University of Toronto, Dr. Alisa Naiman, a family doctor practicing comprehensive primary care in Toronto, and Dr. Malcolm Moore, Medical Oncologist of Princess Margaret Cancer Centre. This week: there's an interesting study published in the Canadian Medical Association Journal on people going to emergency rooms just before being diagnosed with cancer, or being diagnosed with cancer while there. On the positive side, the first new nursing program in 20 years was announced. It comes after the Ford government announced restrictions on medical school admission designed to boost the number of doctors here in Ontario. DONALD TRUMP HAS WON THE U.S. ELECTION Libby Znaimer is joined by Whitley Yates, a Republican strategist and founder and owner of The Niche Agency, as well as Dr. Chris Cooper, a Political Science Professor at Western Carolina University. After months of coverage and dramatic twists and turns in the U.S. Presidential contest, Donald Trump secured a decisive victory. We discuss that and analyze some of the promises he's made during the campaign. WHAT TO KNOW ABOUT THE UPDATED COVID-19 VACCINES AVAILABLE NOW Libby is joined by Pharmacist Molly Yang, Director of Pharmacy Innovation; Professional Affairs at Whole Health Pharmacy. Have you had the latest COVID-19 booster? What about the flu shot? The latest guidance is to take them together, but there are also other vaccines Zoomers should be getting to prevent difficult and possibly debilitating bouts of illness.

THE MEDICAL RECORD: WE NEED TO TALK ABOUT SCURVY   Libby Znaimer is joined by Dr. Malcolm Moore, Medical Oncologist, Princess Margaret Cancer Centre and former head of BC Cancer, Dr. Alisa Naiman, a family doctor in Toronto and Dr. Jamie Spiegelman, internal medicine and critical care physician at Humber River Hospital. Scurvy - a disease we thought was consigned to the history books - has reappeared and food insecurity seems to be the culprit here according to a study published in in the Canadian Medical Association Journal. And, what a study out of the University of Waterloo tells us about breakfast. CRTC WANTS CANADA'S BIG CELL PROVIDERS TO LOWER THEIR INTERNATIONAL ROAMING FEES Libby Znaimer is now joined by Jean-François Mezei, a telecommunications consultant based in Montreal and Carmi Levy,  a technology analyst and journalist based in London, Ontario The CRTC wants Canada's three big cell companies--Bell, Rogers and Telus--to reduce their international roaming charges. We take a deep dive into what these companies are currently charging customers and how it compares to other countries in the world. HAVE YOUR GROOMING HABITS CHANGED SINCE THE PANDEMIC?  Libby is joined by Bernadette Morra, the former Editor-in-chief of FASHION magazine and now a luxury lifestyle writer, as well as Derick Chetty, a fashion professional with Zoomer Media. A Globe and Mail article on this very topic piqued our interest. If you are working from home, has that changed anything about your grooming practices? And what about those of us who are retired?

Artificial intelligence is saving lives. A study recently published by the Canadian Medical Association Journal shows that there was a 26 per cent drop in unexpected deaths among hospitalized patients after an AI system was implemented. Dr. Rob Fraser, health tech expert and founding CEO and is the current President and CSO of Molecular You Corporation, joins Evan to explain why.

Like this? Get AIDAILY, delivered to your inbox, every weekday. Subscribe to our newsletter at https://aidaily.us What Is the Dead Internet Theory? The dead internet theory suggests that much of the web is populated by bots rather than humans, generating and engaging with content. Emerging in 2021, the theory has gained traction with the rise of AI tools, although no compelling evidence supports it. Human and AI interactions are increasingly intertwined online.  AI Could Help Workers Find Greater Purpose by Reducing Mundane Tasks AI may free workers from mundane tasks, enabling them to focus on more meaningful, human-centric aspects of their jobs. Experts suggest AI could enhance creativity, skill development, and workplace relationships. However, its role in replacing human interaction raises concerns about job satisfaction AI Tool Cuts Deaths in Toronto Hospital by 26%, New Study Shows St. Michael's Hospital in Toronto has deployed an AI tool, Chartwatch, that alerts clinicians to patients' deteriorating conditions. A study published in the Canadian Medical Association Journal revealed that using this AI system reduced unexpected deaths by 26%. The AI monitors patients' vitals and lab results, enabling faster interventions without replacing traditional care. Researchers are hopeful for wider deployment across Ontario hospitals.  AI Overload: Why The Hype Needs a Reality Check AI is increasingly overhyped, but it remains a tool—not an all-powerful force. Instead of being captivated by "AI-powered" labels, businesses should focus on use-case-driven applications that offer real value, like improving efficiency and reducing costs. A market correction is inevitable, shifting focus from buzzwords to tangible benefits. AI's Role in Early Detection of Esophageal Cancer Could Save Lives Esophageal cancer is difficult to detect early, leading to low survival rates. AI offers a breakthrough by improving screening accuracy, analyzing thousands of data points to identify high-risk patients more effectively than current guidelines. Doctors hope AI will increase early detection rates and improve patient outcomes. OnlyFans Creators Lead AI Adoption in the Creator Economy OnlyFans creators are driving AI integration by using tools that personalize communication, optimize content distribution, and provide audience insights. These innovations have led to significant revenue growth for many, while also influencing the development of AI tools across platforms. Creators are setting new standards by balancing authenticity with AI-driven engagement

THE ZOOMER SQUAD:  AGEISM AT WORK & WHAT DOCS ARE SAYING ABOUT OZEMPIC FOR ADULTS 65 + Tasha Kheiriddin is joined by Anthony Quinn, Chief Community Officer of CARP,  Bill VanGorder, Chief Advocacy and Education Officer of CARP, and John Wright, Executive Vice President of Maru Public Opinion. This week: we kick things off with a discussion about ageism in the workplace and when you should claim your government pension. AIR CANADA PILOTS COULD GO ON STRIKE NEXT MONTH Tasha Kheiriddin is joined by Dr. Gabor Lukacs, Founder and President of Air Passenger Rights and Dr. Karl Moore, Associate Professor, Strategy & Organization at the Desautels Faculty of Management at McGill University. Air Canada pilots could go on strike as early as September 17th after 98 percent of them voted in favour of a strike mandate should negotiations fail. So, how will this impact travelers and what can Ottawa do about this? HOW AN INCREASE IN FOR-PROFIT CATARACT SURGERIES IS IMPACTING LOWER INCOME SENIORS Tasha Kheiriddin is now joined by Maureen Munro, a senior who has received cataract surgery at a private clinic in London, Ontario and John Mastronardi, a spokesperson for the Ontario Association of Optometrists. A new study published in the Canadian Medical Association Journal shows the extent to which lower income Seniors are facing barriers when it comes to accessing cataract surgery at for-profit clinics in Ontario.

More and more Canadians are unable to access public primary healthcare, according to a study published in the Canadian Medical Association Journal at the beginning of December, 2023. In fact, about 20% of Canadians have no family doctor at all, and many more have irregular access to clinicians. The CMAJ study compares the Canadian primary care system with New Zealand and eight countries in Europe including France, Germany, Italy and the UK. Dr Tara Kiran is the senior author of the study and a family physician and scientist at St. Michael's Hospital and the University of Toronto.

In this episode, breast surgical oncologist and president of the Black Physicians' Association of Ontario, Dr. Mojola Omole, joins us to talk about her advocacy work. She shares how she aims to increase the percentage of Black physicians in Ontario, reduce systemic barriers and racism in medicine, and support Black mental health. We also discuss the need for more robust data that accounts for racial differences to inform screening recommendations. Among the highlights in this episode: 01:50: Dr. Omole shares her reasons for specializing in breast cancer, emphasizing her enjoyment of its multidisciplinary approach and the opportunity it presents for impactful advocacy and community outreach 04:31: Dr. Omole discusses the systemic barriers preventing Black individuals from entering the medical field 06:08: Dr. Omole talks about her work with the Canadian Medical Association Journal 07:10: Dr. Omole explains the misconceptions around 'over-screening' and emphasizes the importance of recognizing biological differences across populations in medical treatment and screening practices 09:15: Dr. Omole discusses the lack of training in medical schools regarding the variations in disease presentation across different populations, emphasizing the need for medical education to incorporate diverse biological and social contexts 11:15: Dr. Omole discusses the Canadian taskforce on preventative health care's recommendations on breast cancer screening, arguing they do not reflect the earlier ages at which women of certain ethnic backgrounds typically present with breast cancer 13:20: Dr. Omole suggests that economic considerations heavily influence national screening recommendations in Canada, which may lead to later diagnoses and poorer outcomes in underrepresented populations 15:00: Zoe reflects on the conversation, noting the critical shortage of family physicians in Canada, which impacts routine screening and health care access 15:19: Dr. Omole offers advice to other health care providers on staying informed and understanding the unique risk factors and needs of diverse patient populations to provide better, more personalized care 16:19: What our hosts learned from this episode Contact Our Hosts Steven Newmark, Chief of Policy at GHLF: snewmark@ghlf.org Zoe Rothblatt, Director of Community Outreach at GHLF: zrothblatt@ghlf.org A podcast episode produced by Ben Blanc, Associate Director, Digital Production and Engagement at GHLF. We want to hear what you think. Send your comments in the form of an email, video, or audio clip of yourself to podcasts@ghlf.org Catch up on all our episodes on our website or on your favorite podcast channel.See omnystudio.com/listener for privacy information.

Cancer continues to be the biggest killer in Canada, but a new study published in the Canadian Medical Association Journal says more people are surviving up to 25 years after being diagnosed. Host Jeff Douglas is joined by Globe and Mail health columnist Andre Picard to get the details.

All four of my children were born at home. I feel extremely fortunate about this - they should too. Four wonderful experiences. I will forever be in debt to Louisa and Jolie.When, twenty-four years ago, my then wife, Louisa, told me she wanted to give birth to our first child at home, I thought she was off her rocker, but I gave her my word that we would at least talk to a midwife, and we did just that. Within about five minutes of meeting Tina Perridge of South London Independent Midwives, a lady of whom I cannot speak highly enough, I was instantly persuaded. Ever since, when I hear that someone is pregnant, I start urging them to have a homebirth with the persistence of a Jehovah's Witness or someone pedalling an upgrade to your current mobile phone subscription. I even included a chapter about it in my first book Life After the State - Why We Don't Need Government (2013), (now, thanks to the invaluable help of my buddy Chris P, back in print - with the audiobook here [Audible UK, Audible US, Apple Books]).I'm publishing that chapter here, something I was previously not able to do (rights issues), because I want as many people as possible to read it. Many people do not even know home-birth is an option. I'm fully aware that, when it comes to giving birth, one of the last people a prospective mum wants to hear advice from is comedian and financial writer, Dominic Frisby. I'm also aware that this is an extremely sensitive subject and that I am treading on eggshells galore. But the word needs to be spread. All I would say is that if you or someone you know is pregnant, have a conversation with an independent midwife, before committing to having your baby in a hospital. It's so important. Please just talk to an independent midwife first. With that said, here is that chapter. Enjoy it, and if you know anyone who is pregnant, please send this to them.We have to use fiat money, we have to pay taxes, most of us are beholden in some way to the education system. These are all things much bigger than us, over which we have little control. The birth of your child, however, is one of the most important experiences of your (and their) life, one where the state so often makes a mess of things, but one where it really is possible to have some control.The State: Looking After Your First BreathThe knowledge of how to give birth without outside interventions lies deep within each woman. Successful childbirth depends on an acceptance of the process.Suzanne Arms, authorThere is no single experience that puts you more in touch with the meaning of life than birth. A birth should be a happy, healthy, wonderful experience for everyone involved. Too often it isn't.Broadly speaking, there are three places a mother can give birth: at home, in hospital or – half-way house – at a birthing centre. Over the course of the 20th century we have moved birth from the home to the hospital. In the UK in the 1920s something like 80% of births took place at home. In the 1960s it was one in three. By 1991 it was 1%. In Japan the home-birth rate was 95% in 1950 falling to 1.2% in 1975. In the US home-birth went from 50% in 1938 to 1% in 1955. In the UK now 2.7% of births take place at home. In Scotland, 1.2% of births take place at home, and in Northern Ireland this drops to fewer than 0.4%. Home-birth is now the anomaly. But for several thousand years, it was the norm.The two key words here are ‘happy' and ‘healthy'. The two tend to come hand in hand. But let's look, first, at ‘healthy'. Let me stress, I am looking at planned homebirth; not a homebirth where mum didn't get to the hospital in time.My initial assumption when I looked at this subject was that hospital would be more healthy. A hospital is full of trained personnel, medicine and medical equipment. My first instinct against home-birth, it turned out, echoed the numerous arguments against it, which come from many parts of the medical establishment. They more or less run along the lines of this statement from the American College of Obstetrics and Gynaecology: ‘Unless a woman is in a hospital, an accredited free-standing birthing centre or a birthing centre within a hospital complex, with physicians ready to intervene quickly if necessary, she puts herself and her baby's health and life at unnecessary risk.'Actually, the risk of death for babies born at home is almost half that of babies born at hospital (0.35 per 1,000 compared to 0.64), according to a 2009 study by the Canadian Medical Association Journal. The National Institute for Health and Clinical Excellence reports that mortality rates are the same in booked home-birth as in hospitals. In November 2011 a study of 65,000 mothers by the National Perinatal Epidemiology Unit (NPEU) was published in the British Medical Journal. The overall rate of negative birth outcomes (death or serious complications) was 4.3 per 1,000 births, with no difference in outcome between non-obstetric and obstetric (hospital) settings. The study did find that the rate of complications rose for first-time mums, 5.3 per 1,000 (0.53%) for hospitals and 9.5 per 1,000 (0.95%) for home-birth. I suspect the number of complications falls with later births because, with experience, the process becomes easier – and because mothers who had problems are less likely to have more children than those who didn't. The Daily Mail managed to twist this into: ‘First-time mothers who opt for home birth face triple the risk of death or brain damage in child.' Don't you just love newspapers? Whether at home or in the hospital there were 250 negative events seen in the study: early neonatal deaths accounted for 13%; brain damage 46%; meconium aspiration syndrome 20%; traumatic nerve damage 4% and fractured bones 4%. Not all of these were treatable.There are so many variables in birth that raw comparative statistics are not always enough. And, without wishing to get into an ethical argument, there are other factors apart from safety. There are things – comfort, happiness, for example – for which people are prepared to sacrifice a little safety. The overriding statistic to take away from that part of the study is that less than 1% of births in the UK, whether at hospital or at home, lead to serious complications.But when you look at rates of satisfaction with their birth experience, the numbers are staggering. According to a 1999 study by Midwifery Today researching women who have experienced both home and hospital birth, over 99% said that they would prefer to have a home-birth in the future!What, then, is so unsatisfying about the hospital birth experience? I'm going to walk through the birthing process now, comparing what goes on at home to hospital. Of course, no two births are the same, no two homes are the same, no two hospitals are the same, but, broadly speaking, it seems women prefer the home-birth experience because: they have more autonomy at home, they suffer less intervention at home and, yes, it appears they actually suffer less pain at home. When mum goes into labour, the journey to the hospital, sometimes rushed, the alien setting when she gets there, the array of doctors and nurses who she may never have met before, but are about to get intimate, can all upset her rhythm and the production of her labour hormones. These aren't always problems, but they have the potential to be; they add to stress and detract from comfort.At home, mum is in a familiar environment, she can get comfortable and settled, go where she likes and do what she likes. Often getting on with something else can take her mind off the pain of the contractions, while in hospital there is little else to focus on. At home, she can choose where she wants to give birth – and she can change her mind, if she likes. She is in her own domain, without someone she doesn't know telling her what she can and can't do. She can change the light, the heating, the music; she can decide exactly who she wants at the birth and who ‘catches' her baby. She can choose what she wants to eat. She will have interviewed and chosen her midwife many months before, and built up a relationship over that time. But in hospitals she is attended by whoever is on duty, she has to eat hospital food, there might be interruptions, doctors' pagers, alarms, screams from next door, whirrs of machinery, tube lighting, overworked, resentful staff to deal with, internal hospital politics, people coming in, waking her up, and checking her vitals, sticking in pins or needles, putting on monitor belts, checking her cervix mid-contraction – any number of things over which mum has no control. Mums who move about freely during labour complain less of back pain. Many authorities feel that the motion of walking and changing positions can even enhance the effectiveness of the contractions, but such active birth is not as possible in the confines of many hospitals. Many use intravenous fluids and electronic foetal monitors to ensure she stays hydrated and to record each contraction and beat of the baby's heart. This all dampens mum's ability to move about and adds to any feelings of claustrophobia.In hospital the tendency is to give birth on your back, though this is often not the best position – the coccyx cannot bend to help the baby's head pass through. There are many other positions – on your hands and knees for example – where you don't have to work against gravity and where the baby's head is not impeded. On your back, pushing is less effective and metal forceps are sometimes used to pull the baby out of the vagina, but forceps are less commonly used when mum assumes a position of comfort during the bearing-down stage.This brings us to the next issue: intervention. The NPEU study of 2011 found that 58% of women in hospital had a natural birth without any intervention, compared to 88% of women at home and 80% of women at a midwife-led unit. Of course, there are frequent occasions when medical technology saves lives, but the likelihood of medical intervention increases in hospitals. I suggest it can actually cause as many problems as it alleviates because it is interruptive. Even routine technology can interrupt the normal birth process. Once derailed from the birthing tracks, it is hard to get back on. Once intervention starts, it's hard to stop. The medical industry is built on providing cures, but if you are a mother giving birth, you are not sick, there is nothing wrong with you, what you are going through is natural and normal. As author Sheila Stubbs writes, ‘the midwife considers the miracle of childbirth as normal, and leaves it alone unless there's trouble. The obstetrician normally sees childbirth as trouble; if he leaves it alone, it's a miracle.'Here are just some of the other interventions that occur. If a mum arrives at hospital and the production of her labour hormones has been interrupted, as can happen as a result of the journey, she will sometimes be given syntocinon, a synthetic version of the hormone oxytocin, which occurs naturally and causes the muscle of the uterus to contract during labour so baby can be pushed out. The dose of syntocinon is increased until contractions are deemed normal. It's sometimes given after birth as well to stimulate the contractions that help push out the placenta and prevent bleeding. But there are allegations that syntocinon increases the risk of baby going into distress, and of mum finding labour too painful and needing an epidural. This is one of the reasons why women also find home-birth less painful.Obstetricians sometimes rupture the bag of waters surrounding the baby in order to speed up the birthing process. This places a time limit on the labour, as the likelihood of a uterine infection increases after the water is broken. Indeed in a hospital – no matter how clean – you are exposed to more pathogens than at home. The rate of post-partum infection to women who give birth in hospital is a terrifying 25%, compared to just 4% in home-birth mothers. Once the protective cushion of water surrounding the baby's head is removed (that is to say, once the waters are broken) there are more possibilities for intervention. A scalp electrode, a tiny probe, might be attached to baby's scalp, to continue monitoring its heart rate and to gather information about its blood.There are these and a whole host of other ‘just in case' interventions in hospital that you just don't meet at home. As childbirth author Margaret Jowitt, says – and here we are back to our theme of Natural Law – ‘Natural childbirth has evolved to suit the species, and if mankind chooses to ignore her advice and interfere with her workings we must not complain about the consequences.'At home, if necessary, in the 1% of cases where serious complications do ensue, you can still be taken to hospital – assuming you live in reasonable distance of one.‘My mother groaned, my father wept,' wrote William Blake, ‘into the dangerous world I leapt.' We come now to the afterbirth. Many new mothers say they physically ache for their babies when they are separated. Nature, it seems, gives new mothers a strong attachment desire, a physical yearning that, if allowed to be satisfied, starts a process with results beneficial to both mother and baby. There are all sorts of natural forces at work, many of which we don't even know about. ‘Incomplete bonding,' on the other hand, in the words of Judith Goldsmith, author of Childbirth Wisdom from the World's Oldest Societies, ‘can lead to confusion, depression, incompetence, and even rejection of the child by the mother.' Yet in hospitals, even today with all we know, the baby is often taken away from the mother for weighing and other tests – or to keep it warm, though there is no warmer place for it that in its mother's arms (nature has planned for skin-to-skin contact).Separation of mother from baby is more likely if some kind of medical intervention or operation has occurred, or if mum is recovering from drugs taken during labour. (Women who have taken drugs in labour also report decreased maternal feelings towards their babies and increased post-natal depression). At home, after birth, baby is not taken from its mother's side unless there is an emergency.As child development author, Joseph Chilton Pearce, writes, ‘Bonding is a psychological-biological state, a vital physical link that coordinates and unifies the entire biological system . . . We are never conscious of being bonded; we are conscious only of our acute disease when we are not bonded.' The breaking of the bond results in higher rates of postpartum depression and child rejection. Nature gives new parents and babies the desire to bond, because bonding is beneficial to our species. Not only does it encourage breastfeeding and speed the recovery of the mother, but the emotional bonding in the magical moments after birth between mother and child, between the entire family, cements the unity of the family. The hospital institution has no such agenda. The cutting of the umbilical cord is another area of contention. Hospitals, say home-birth advocates, cut it too soon. In Birth Without Violence, the classic 1975 text advocating gentle birthing techniques, Frederick Leboyer – also an advocate of bonding and immediate skin-to-skin contact between mother and baby after birth – writes:[Nature] has arranged it so that during the dangerous passage of birth, the child is receiving oxygen from two sources rather than one: from the lungs and from the umbilicus. Two systems functioning simultaneously, one relieving the other: the old one, the umbilicus, continues to supply oxygen to the baby until the new one, the lungs, has fully taken its place. However, once the infant has been born and delivered from the mother, it remains bound to her by this umbilicus, which continues to beat for several long minutes: four, five, sometimes more. Oxygenated by the umbilicus, sheltered from anoxia, the baby can settle into breathing without danger and without shock. In addition, the blood has plenty of time to abandon its old route (which leads to the placenta) and progressively to fill the pulmonary circulatory system. During this time, in parallel fashion, an orifice closes in the heart, which seals off the old route forever. In short, for an average of four or five minutes, the newborn infant straddles two worlds. Drawing oxygen from two sources, it switches gradually from the one to the other, without a brutal transition. One scarcely hears a cry. What is required for this miracle to take place? Only a little patience.Patience is not something you associate with hospital birth. There are simply not the resources, even if, as the sixth US president John Quincy Adams said, ‘patience and perseverance have a magical effect before which difficulties disappear and obstacles vanish'. The arguments to delay the early cutting of the cord (something not as frequent in hospitals as it once was) are that, even though blood going back to the placenta stops flowing – or pulsing – non-pulsing blood going from the placenta into baby is still flowing. After birth, 25–35% of baby's oxygenated blood remains in the placenta for up to ten minutes. With the cord cut early, baby is less likely to receive this blood, making cold stress, infant jaundice, anaemia, Rh disease and even a delayed maternal placental expulsion more likely. There is also the risk of oxygen deprivation and circulatory shock, as baby gasps for breath before his nasal passages have naturally drained their mucus and amniotic fluid. Scientist W. F. Windle has even argued that, starved of blood and oxygen, brain cells will die, so cutting the cord too early even sets the stage for brain damage.Natural birth advocates say it is vital for the baby's feeding to be put to the breast as soon as possible after birth, while his sucking instincts are strongest. Bathing, measuring and temperature-taking can wait. Babies are most alert during the first hour after birth, so it's important to take advantage of this before they settle into that sleepy stage that can last for hours or even days.Colostrum, the yellow fluid that breasts start producing during pregnancy, is nature's first food. is substance performs many roles we know about and probably many we don't as well. Known as ‘baby's first vaccine', it is full of antibodies and protects against many different viruses and bacteria. It has a laxative effect that clears meconium – baby's black and tarry first stool – out of the system. If this isn't done, baby can be vulnerable to jaundice. Colostrum lines baby's stomach ready for its mother's milk, which comes two or three days later, and it meets baby's nutritional needs with a naturally occurring balance of fat, protein and carbohydrate. Again, with the various medical interventions that go on in hospitals, from operations to drug-taking to simply separating mother and baby, this early breast-feeding process can easily be derailed. Once derailed, as I've said, it's often hard to get back on track. I am no scientist and cannot speak with any authority on the science behind it all, but I do know that nature, very often, plans for things that science has yet to discover.Once upon a time, when families lived closer together and people had more children at a younger age, there was an immediate family infrastructure around you. People were experienced with young. If mum was tired, nan or auntie could feed the baby. Many of us are less fortunate in this regard today. With a hospital, you are sent home and, suddenly, you and your partner are on your own with a baby in your life, and very little aftercare. When my first son was born I was 30. I suddenly realized I had only held a baby once before. I was an only child so I had never looked after a younger brother or sister; my cousins, who had had children, lived abroad. Suddenly there was this living thing in my life, and I didn't know what to do. But, having had a home-birth, the midwife, who you already know, can you give you aftercare. She comes and visits, helps with the early breastfeeding process and generally supports and keeps you on the right tracks.It's so important to get the birthing process right. There are all sorts of consequences to our health and happiness to not doing so. And in the West, with the process riddled as it is with intervention, we don't. We need to get birth out of the hospital and into an environment where women experience less pain, lower levels of intervention, greater autonomy and increased satisfaction.A 2011 study by a team from Peking University and the London School of Hygiene found that, of 1.5 million births in China between 1996 and 2008, babies born in hospitals were two to three times less likely to die. China is at a similar stage in its evolutionary cycle to the developed world at the beginning of the 20th century. The move to hospitals there looks inevitable. Something similar is happening in most Developing Nations.In his book A History of Women's Bodies, Edward Shorter quotes a doctor describing a birth in a working-class home in the 1920s:You find a bed that has been slept on by the husband, wife and one or two children; it has frequently been soaked with urine, the sheets are dirty, and the patient's garments are soiled, she has not had a bath. Instead of sterile dressings you have a few old rags or the discharges are allowed to soak into a nightdress which is not changed for days.For comparison, he describes a 1920s hospital birth:The mother lies in a well-aired disinfected room, light and sunlight stream unhindered through a high window and you can make it light as day electrically too. She is well bathed and freshly clothed on linen sheets of blinding whiteness . . . You have a staff of assistants who respond to every signal . . . Only those who have to repair a perineum in a cottars's house in a cottar's bed with the poor light and help at hand can realize the joy.Most homes in the developed world are no longer as he describes, if they ever were, except in slums. It would seem the evolution in the way we give birth as a country develops passes from the home to the hospital. It is time to take it away from the hospital.Why am I spending so much time on birth in a book about economics? The process of giving birth is yet another manifestation of this culture of pervasive state intervention. (Hospitals, of course, are mostly state run.) It's another example of something that feels safer, if provided by the state in a hospital, even if the evidence is to the contrary. And it's another example of the state destroying for so many something that is beautiful and wonderful.What's more, like so many things that are state-run, hospital birth is needlessly expensive. The November 2011 study of 65,000 mothers by the National Perinatal Epidemiology Unit looked at the average costs of birth in the NHS. They were highest for planned obstetric unit births and lowest for planned home-births. Here they are:* £1,631 (c. $2,600) for a planned birth in an obstetric unit * £1,461 (c. $2,340 for a planned birth in an alongside midwifery unit (AMU)* £1,435 (c. $2,300) for a planned birth in a free-standing midwifery unit (FMU)* £1,067 (c. $1,700) for a planned home-birth.Not only is it as safe; not only are people more satisfied by it; not only do the recipients receive more one-to-one – i.e. better – care; home-birth is also 35% cheaper. Intervention is expensive.So I return to this theme of non-intervention, whether in hospitals or economies. It often looks cruel, callous and hard-hearted; it often looks unsafe, but, counter-intuitively perhaps, in the end it is more human and more humane.When you look at the cost of private birth, the argument for home-birth is even more compelling. Private maternity care is expensive. For example, in summer 2012, a first birth at the Portland Hospital in London costs £2,880 (about $4,400) for a normal delivery and £3,790 (about $5,685) for an elective caesarean and for the first 24 hours of care. Additional nights in a standard room cost around £1,000 (about $1,500). You also have to allow for the fees charged by your private consultant obstetrician, which might be £3,000–£4,000 ($4,500– $6,000). So, in total, a private birth at a hospital such as the Portland could cost £7,500–£10,000 ($10–$15,000). There will be some saving if you opt for a ‘midwife-led delivery service' or ‘midwife-led care'. In this instance, you will still have a named obstetrician, but he or she will see you less often, and the birth may be ‘supported by an on-call Consultant Obstetrician'. London midwives charge £2,500–£4,000 (c. $4–6,000) for about six months of care from early pregnancy to a month after birth. The comparative value is astounding, I would say.To have a planned home-birth on the NHS is possible, but can be problematic to arrange, depending on where you are based. Most people, after they have paid taxes, do not now have the funds to buy a private home-birth, so they are forced into the arms of government health care, such is the cycle at work.I was first introduced to the idea of home-birth by my ex-wife, Louisa, something for which I will forever be grateful. She hated hospitals due to an earlier experience in her life and only found out about alternatives thanks to the internet. I, as well as my friends and family, thought Louisa was insane. But she insisted. And she was right to.Our first son was actually two weeks and six days late. Because he was so late, we were obliged to go to the hospital, which we did, after two weeks and five days. We were kept waiting so long in there, we decided to go and persuaded an overworked nurse that we were fine to go and we left. The confused nurse was glad to have one less thing to think about. The next day Samuel was born: a beautiful and wonderful experience that I will never forget, one of the happiest days of my life – exactly as nature intended.Simply talking to people that have experienced both home-birth and hospital birth, or reading about their experiences, the anecdotal evidence is compelling. Home-birth may not be for everyone – I'm not suggesting it is. Birthing centres seem a good way forward. But a hospital birth should only be for emergencies. Childbirth is a natural process that no longer requires hospitalization, except in those 1% of situations where something goes seriously wrong. If it does go wrong and there is an emergency, call an ambulance and be taken to hospital – that is what they are for.Returning to the original premise of Natural and Positive Law, it's pretty clear which category hospital birth falls into. Hospitals do things in the way that they do because of the pressures they are under, not least the threat of legal action should some procedural failure occur. Taking birth back home and away from the state reduces the burden of us on it and of it on us.Life After the State - Why We Don't Need Government (2013) is now back in print - with the audiobook here: Audible UK, Audible US, Apple Books. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.theflyingfrisby.com/subscribe

All four of my children were born at home. I feel extremely fortunate about this - they should too. Four wonderful experiences. I will forever be in debt to Louisa and Jolie.When, twenty-four years ago, my then wife, Louisa, told me she wanted to give birth to our first child at home, I thought she was off her rocker, but I gave her my word that we would at least talk to a midwife, and we did just that. Within about five minutes of meeting Tina Perridge of South London Independent Midwives, a lady of whom I cannot speak highly enough, I was instantly persuaded. Ever since, when I hear that someone is pregnant, I start urging them to have a homebirth with the persistence of a Jehovah's Witness or someone pedalling an upgrade to your current mobile phone subscription. I even included a chapter about it in my first book Life After the State - Why We Don't Need Government (2013), (now, thanks to the invaluable help of my buddy Chris P, back in print - with the audiobook here [Audible UK, Audible US, Apple Books]).I'm publishing that chapter here, something I was previously not able to do (rights issues), because I want as many people as possible to read it. Many people do not even know home-birth is an option. I'm fully aware that, when it comes to giving birth, one of the last people a prospective mum wants to hear advice from is comedian and financial writer, Dominic Frisby. I'm also aware that this is an extremely sensitive subject and that I am treading on eggshells galore. But the word needs to be spread. All I would say is that if you or someone you know is pregnant, have a conversation with an independent midwife, before committing to having your baby in a hospital. It's so important. Please just talk to an independent midwife first. With that said, here is that chapter. Enjoy it, and if you know anyone who is pregnant, please send this to them.We have to use fiat money, we have to pay taxes, most of us are beholden in some way to the education system. These are all things much bigger than us, over which we have little control. The birth of your child, however, is one of the most important experiences of your (and their) life, one where the state so often makes a mess of things, but one where it really is possible to have some control.The State: Looking After Your First BreathThe knowledge of how to give birth without outside interventions lies deep within each woman. Successful childbirth depends on an acceptance of the process.Suzanne Arms, authorThere is no single experience that puts you more in touch with the meaning of life than birth. A birth should be a happy, healthy, wonderful experience for everyone involved. Too often it isn't.Broadly speaking, there are three places a mother can give birth: at home, in hospital or – half-way house – at a birthing centre. Over the course of the 20th century we have moved birth from the home to the hospital. In the UK in the 1920s something like 80% of births took place at home. In the 1960s it was one in three. By 1991 it was 1%. In Japan the home-birth rate was 95% in 1950 falling to 1.2% in 1975. In the US home-birth went from 50% in 1938 to 1% in 1955. In the UK now 2.7% of births take place at home. In Scotland, 1.2% of births take place at home, and in Northern Ireland this drops to fewer than 0.4%. Home-birth is now the anomaly. But for several thousand years, it was the norm.The two key words here are ‘happy' and ‘healthy'. The two tend to come hand in hand. But let's look, first, at ‘healthy'. Let me stress, I am looking at planned homebirth; not a homebirth where mum didn't get to the hospital in time.My initial assumption when I looked at this subject was that hospital would be more healthy. A hospital is full of trained personnel, medicine and medical equipment. My first instinct against home-birth, it turned out, echoed the numerous arguments against it, which come from many parts of the medical establishment. They more or less run along the lines of this statement from the American College of Obstetrics and Gynaecology: ‘Unless a woman is in a hospital, an accredited free-standing birthing centre or a birthing centre within a hospital complex, with physicians ready to intervene quickly if necessary, she puts herself and her baby's health and life at unnecessary risk.'Actually, the risk of death for babies born at home is almost half that of babies born at hospital (0.35 per 1,000 compared to 0.64), according to a 2009 study by the Canadian Medical Association Journal. The National Institute for Health and Clinical Excellence reports that mortality rates are the same in booked home-birth as in hospitals. In November 2011 a study of 65,000 mothers by the National Perinatal Epidemiology Unit (NPEU) was published in the British Medical Journal. The overall rate of negative birth outcomes (death or serious complications) was 4.3 per 1,000 births, with no difference in outcome between non-obstetric and obstetric (hospital) settings. The study did find that the rate of complications rose for first-time mums, 5.3 per 1,000 (0.53%) for hospitals and 9.5 per 1,000 (0.95%) for home-birth. I suspect the number of complications falls with later births because, with experience, the process becomes easier – and because mothers who had problems are less likely to have more children than those who didn't. The Daily Mail managed to twist this into: ‘First-time mothers who opt for home birth face triple the risk of death or brain damage in child.' Don't you just love newspapers? Whether at home or in the hospital there were 250 negative events seen in the study: early neonatal deaths accounted for 13%; brain damage 46%; meconium aspiration syndrome 20%; traumatic nerve damage 4% and fractured bones 4%. Not all of these were treatable.There are so many variables in birth that raw comparative statistics are not always enough. And, without wishing to get into an ethical argument, there are other factors apart from safety. There are things – comfort, happiness, for example – for which people are prepared to sacrifice a little safety. The overriding statistic to take away from that part of the study is that less than 1% of births in the UK, whether at hospital or at home, lead to serious complications.But when you look at rates of satisfaction with their birth experience, the numbers are staggering. According to a 1999 study by Midwifery Today researching women who have experienced both home and hospital birth, over 99% said that they would prefer to have a home-birth in the future!What, then, is so unsatisfying about the hospital birth experience? I'm going to walk through the birthing process now, comparing what goes on at home to hospital. Of course, no two births are the same, no two homes are the same, no two hospitals are the same, but, broadly speaking, it seems women prefer the home-birth experience because: they have more autonomy at home, they suffer less intervention at home and, yes, it appears they actually suffer less pain at home. When mum goes into labour, the journey to the hospital, sometimes rushed, the alien setting when she gets there, the array of doctors and nurses who she may never have met before, but are about to get intimate, can all upset her rhythm and the production of her labour hormones. These aren't always problems, but they have the potential to be; they add to stress and detract from comfort.At home, mum is in a familiar environment, she can get comfortable and settled, go where she likes and do what she likes. Often getting on with something else can take her mind off the pain of the contractions, while in hospital there is little else to focus on. At home, she can choose where she wants to give birth – and she can change her mind, if she likes. She is in her own domain, without someone she doesn't know telling her what she can and can't do. She can change the light, the heating, the music; she can decide exactly who she wants at the birth and who ‘catches' her baby. She can choose what she wants to eat. She will have interviewed and chosen her midwife many months before, and built up a relationship over that time. But in hospitals she is attended by whoever is on duty, she has to eat hospital food, there might be interruptions, doctors' pagers, alarms, screams from next door, whirrs of machinery, tube lighting, overworked, resentful staff to deal with, internal hospital politics, people coming in, waking her up, and checking her vitals, sticking in pins or needles, putting on monitor belts, checking her cervix mid-contraction – any number of things over which mum has no control. Mums who move about freely during labour complain less of back pain. Many authorities feel that the motion of walking and changing positions can even enhance the effectiveness of the contractions, but such active birth is not as possible in the confines of many hospitals. Many use intravenous fluids and electronic foetal monitors to ensure she stays hydrated and to record each contraction and beat of the baby's heart. This all dampens mum's ability to move about and adds to any feelings of claustrophobia.In hospital the tendency is to give birth on your back, though this is often not the best position – the coccyx cannot bend to help the baby's head pass through. There are many other positions – on your hands and knees for example – where you don't have to work against gravity and where the baby's head is not impeded. On your back, pushing is less effective and metal forceps are sometimes used to pull the baby out of the vagina, but forceps are less commonly used when mum assumes a position of comfort during the bearing-down stage.This brings us to the next issue: intervention. The NPEU study of 2011 found that 58% of women in hospital had a natural birth without any intervention, compared to 88% of women at home and 80% of women at a midwife-led unit. Of course, there are frequent occasions when medical technology saves lives, but the likelihood of medical intervention increases in hospitals. I suggest it can actually cause as many problems as it alleviates because it is interruptive. Even routine technology can interrupt the normal birth process. Once derailed from the birthing tracks, it is hard to get back on. Once intervention starts, it's hard to stop. The medical industry is built on providing cures, but if you are a mother giving birth, you are not sick, there is nothing wrong with you, what you are going through is natural and normal. As author Sheila Stubbs writes, ‘the midwife considers the miracle of childbirth as normal, and leaves it alone unless there's trouble. The obstetrician normally sees childbirth as trouble; if he leaves it alone, it's a miracle.'Here are just some of the other interventions that occur. If a mum arrives at hospital and the production of her labour hormones has been interrupted, as can happen as a result of the journey, she will sometimes be given syntocinon, a synthetic version of the hormone oxytocin, which occurs naturally and causes the muscle of the uterus to contract during labour so baby can be pushed out. The dose of syntocinon is increased until contractions are deemed normal. It's sometimes given after birth as well to stimulate the contractions that help push out the placenta and prevent bleeding. But there are allegations that syntocinon increases the risk of baby going into distress, and of mum finding labour too painful and needing an epidural. This is one of the reasons why women also find home-birth less painful.Obstetricians sometimes rupture the bag of waters surrounding the baby in order to speed up the birthing process. This places a time limit on the labour, as the likelihood of a uterine infection increases after the water is broken. Indeed in a hospital – no matter how clean – you are exposed to more pathogens than at home. The rate of post-partum infection to women who give birth in hospital is a terrifying 25%, compared to just 4% in home-birth mothers. Once the protective cushion of water surrounding the baby's head is removed (that is to say, once the waters are broken) there are more possibilities for intervention. A scalp electrode, a tiny probe, might be attached to baby's scalp, to continue monitoring its heart rate and to gather information about its blood.There are these and a whole host of other ‘just in case' interventions in hospital that you just don't meet at home. As childbirth author Margaret Jowitt, says – and here we are back to our theme of Natural Law – ‘Natural childbirth has evolved to suit the species, and if mankind chooses to ignore her advice and interfere with her workings we must not complain about the consequences.'At home, if necessary, in the 1% of cases where serious complications do ensue, you can still be taken to hospital – assuming you live in reasonable distance of one.‘My mother groaned, my father wept,' wrote William Blake, ‘into the dangerous world I leapt.' We come now to the afterbirth. Many new mothers say they physically ache for their babies when they are separated. Nature, it seems, gives new mothers a strong attachment desire, a physical yearning that, if allowed to be satisfied, starts a process with results beneficial to both mother and baby. There are all sorts of natural forces at work, many of which we don't even know about. ‘Incomplete bonding,' on the other hand, in the words of Judith Goldsmith, author of Childbirth Wisdom from the World's Oldest Societies, ‘can lead to confusion, depression, incompetence, and even rejection of the child by the mother.' Yet in hospitals, even today with all we know, the baby is often taken away from the mother for weighing and other tests – or to keep it warm, though there is no warmer place for it that in its mother's arms (nature has planned for skin-to-skin contact).Separation of mother from baby is more likely if some kind of medical intervention or operation has occurred, or if mum is recovering from drugs taken during labour. (Women who have taken drugs in labour also report decreased maternal feelings towards their babies and increased post-natal depression). At home, after birth, baby is not taken from its mother's side unless there is an emergency.As child development author, Joseph Chilton Pearce, writes, ‘Bonding is a psychological-biological state, a vital physical link that coordinates and unifies the entire biological system . . . We are never conscious of being bonded; we are conscious only of our acute disease when we are not bonded.' The breaking of the bond results in higher rates of postpartum depression and child rejection. Nature gives new parents and babies the desire to bond, because bonding is beneficial to our species. Not only does it encourage breastfeeding and speed the recovery of the mother, but the emotional bonding in the magical moments after birth between mother and child, between the entire family, cements the unity of the family. The hospital institution has no such agenda. The cutting of the umbilical cord is another area of contention. Hospitals, say home-birth advocates, cut it too soon. In Birth Without Violence, the classic 1975 text advocating gentle birthing techniques, Frederick Leboyer – also an advocate of bonding and immediate skin-to-skin contact between mother and baby after birth – writes:[Nature] has arranged it so that during the dangerous passage of birth, the child is receiving oxygen from two sources rather than one: from the lungs and from the umbilicus. Two systems functioning simultaneously, one relieving the other: the old one, the umbilicus, continues to supply oxygen to the baby until the new one, the lungs, has fully taken its place. However, once the infant has been born and delivered from the mother, it remains bound to her by this umbilicus, which continues to beat for several long minutes: four, five, sometimes more. Oxygenated by the umbilicus, sheltered from anoxia, the baby can settle into breathing without danger and without shock. In addition, the blood has plenty of time to abandon its old route (which leads to the placenta) and progressively to fill the pulmonary circulatory system. During this time, in parallel fashion, an orifice closes in the heart, which seals off the old route forever. In short, for an average of four or five minutes, the newborn infant straddles two worlds. Drawing oxygen from two sources, it switches gradually from the one to the other, without a brutal transition. One scarcely hears a cry. What is required for this miracle to take place? Only a little patience.Patience is not something you associate with hospital birth. There are simply not the resources, even if, as the sixth US president John Quincy Adams said, ‘patience and perseverance have a magical effect before which difficulties disappear and obstacles vanish'. The arguments to delay the early cutting of the cord (something not as frequent in hospitals as it once was) are that, even though blood going back to the placenta stops flowing – or pulsing – non-pulsing blood going from the placenta into baby is still flowing. After birth, 25–35% of baby's oxygenated blood remains in the placenta for up to ten minutes. With the cord cut early, baby is less likely to receive this blood, making cold stress, infant jaundice, anaemia, Rh disease and even a delayed maternal placental expulsion more likely. There is also the risk of oxygen deprivation and circulatory shock, as baby gasps for breath before his nasal passages have naturally drained their mucus and amniotic fluid. Scientist W. F. Windle has even argued that, starved of blood and oxygen, brain cells will die, so cutting the cord too early even sets the stage for brain damage.Natural birth advocates say it is vital for the baby's feeding to be put to the breast as soon as possible after birth, while his sucking instincts are strongest. Bathing, measuring and temperature-taking can wait. Babies are most alert during the first hour after birth, so it's important to take advantage of this before they settle into that sleepy stage that can last for hours or even days.Colostrum, the yellow fluid that breasts start producing during pregnancy, is nature's first food. is substance performs many roles we know about and probably many we don't as well. Known as ‘baby's first vaccine', it is full of antibodies and protects against many different viruses and bacteria. It has a laxative effect that clears meconium – baby's black and tarry first stool – out of the system. If this isn't done, baby can be vulnerable to jaundice. Colostrum lines baby's stomach ready for its mother's milk, which comes two or three days later, and it meets baby's nutritional needs with a naturally occurring balance of fat, protein and carbohydrate. Again, with the various medical interventions that go on in hospitals, from operations to drug-taking to simply separating mother and baby, this early breast-feeding process can easily be derailed. Once derailed, as I've said, it's often hard to get back on track. I am no scientist and cannot speak with any authority on the science behind it all, but I do know that nature, very often, plans for things that science has yet to discover.Once upon a time, when families lived closer together and people had more children at a younger age, there was an immediate family infrastructure around you. People were experienced with young. If mum was tired, nan or auntie could feed the baby. Many of us are less fortunate in this regard today. With a hospital, you are sent home and, suddenly, you and your partner are on your own with a baby in your life, and very little aftercare. When my first son was born I was 30. I suddenly realized I had only held a baby once before. I was an only child so I had never looked after a younger brother or sister; my cousins, who had had children, lived abroad. Suddenly there was this living thing in my life, and I didn't know what to do. But, having had a home-birth, the midwife, who you already know, can you give you aftercare. She comes and visits, helps with the early breastfeeding process and generally supports and keeps you on the right tracks.It's so important to get the birthing process right. There are all sorts of consequences to our health and happiness to not doing so. And in the West, with the process riddled as it is with intervention, we don't. We need to get birth out of the hospital and into an environment where women experience less pain, lower levels of intervention, greater autonomy and increased satisfaction.A 2011 study by a team from Peking University and the London School of Hygiene found that, of 1.5 million births in China between 1996 and 2008, babies born in hospitals were two to three times less likely to die. China is at a similar stage in its evolutionary cycle to the developed world at the beginning of the 20th century. The move to hospitals there looks inevitable. Something similar is happening in most Developing Nations.In his book A History of Women's Bodies, Edward Shorter quotes a doctor describing a birth in a working-class home in the 1920s:You find a bed that has been slept on by the husband, wife and one or two children; it has frequently been soaked with urine, the sheets are dirty, and the patient's garments are soiled, she has not had a bath. Instead of sterile dressings you have a few old rags or the discharges are allowed to soak into a nightdress which is not changed for days.For comparison, he describes a 1920s hospital birth:The mother lies in a well-aired disinfected room, light and sunlight stream unhindered through a high window and you can make it light as day electrically too. She is well bathed and freshly clothed on linen sheets of blinding whiteness . . . You have a staff of assistants who respond to every signal . . . Only those who have to repair a perineum in a cottars's house in a cottar's bed with the poor light and help at hand can realize the joy.Most homes in the developed world are no longer as he describes, if they ever were, except in slums. It would seem the evolution in the way we give birth as a country develops passes from the home to the hospital. It is time to take it away from the hospital.Why am I spending so much time on birth in a book about economics? The process of giving birth is yet another manifestation of this culture of pervasive state intervention. (Hospitals, of course, are mostly state run.) It's another example of something that feels safer, if provided by the state in a hospital, even if the evidence is to the contrary. And it's another example of the state destroying for so many something that is beautiful and wonderful.What's more, like so many things that are state-run, hospital birth is needlessly expensive. The November 2011 study of 65,000 mothers by the National Perinatal Epidemiology Unit looked at the average costs of birth in the NHS. They were highest for planned obstetric unit births and lowest for planned home-births. Here they are:* £1,631 (c. $2,600) for a planned birth in an obstetric unit * £1,461 (c. $2,340 for a planned birth in an alongside midwifery unit (AMU)* £1,435 (c. $2,300) for a planned birth in a free-standing midwifery unit (FMU)* £1,067 (c. $1,700) for a planned home-birth.Not only is it as safe; not only are people more satisfied by it; not only do the recipients receive more one-to-one – i.e. better – care; home-birth is also 35% cheaper. Intervention is expensive.So I return to this theme of non-intervention, whether in hospitals or economies. It often looks cruel, callous and hard-hearted; it often looks unsafe, but, counter-intuitively perhaps, in the end it is more human and more humane.When you look at the cost of private birth, the argument for home-birth is even more compelling. Private maternity care is expensive. For example, in summer 2012, a first birth at the Portland Hospital in London costs £2,880 (about $4,400) for a normal delivery and £3,790 (about $5,685) for an elective caesarean and for the first 24 hours of care. Additional nights in a standard room cost around £1,000 (about $1,500). You also have to allow for the fees charged by your private consultant obstetrician, which might be £3,000–£4,000 ($4,500– $6,000). So, in total, a private birth at a hospital such as the Portland could cost £7,500–£10,000 ($10–$15,000). There will be some saving if you opt for a ‘midwife-led delivery service' or ‘midwife-led care'. In this instance, you will still have a named obstetrician, but he or she will see you less often, and the birth may be ‘supported by an on-call Consultant Obstetrician'. London midwives charge £2,500–£4,000 (c. $4–6,000) for about six months of care from early pregnancy to a month after birth. The comparative value is astounding, I would say.To have a planned home-birth on the NHS is possible, but can be problematic to arrange, depending on where you are based. Most people, after they have paid taxes, do not now have the funds to buy a private home-birth, so they are forced into the arms of government health care, such is the cycle at work.I was first introduced to the idea of home-birth by my ex-wife, Louisa, something for which I will forever be grateful. She hated hospitals due to an earlier experience in her life and only found out about alternatives thanks to the internet. I, as well as my friends and family, thought Louisa was insane. But she insisted. And she was right to.Our first son was actually two weeks and six days late. Because he was so late, we were obliged to go to the hospital, which we did, after two weeks and five days. We were kept waiting so long in there, we decided to go and persuaded an overworked nurse that we were fine to go and we left. The confused nurse was glad to have one less thing to think about. The next day Samuel was born: a beautiful and wonderful experience that I will never forget, one of the happiest days of my life – exactly as nature intended.Simply talking to people that have experienced both home-birth and hospital birth, or reading about their experiences, the anecdotal evidence is compelling. Home-birth may not be for everyone – I'm not suggesting it is. Birthing centres seem a good way forward. But a hospital birth should only be for emergencies. Childbirth is a natural process that no longer requires hospitalization, except in those 1% of situations where something goes seriously wrong. If it does go wrong and there is an emergency, call an ambulance and be taken to hospital – that is what they are for.Returning to the original premise of Natural and Positive Law, it's pretty clear which category hospital birth falls into. Hospitals do things in the way that they do because of the pressures they are under, not least the threat of legal action should some procedural failure occur. Taking birth back home and away from the state reduces the burden of us on it and of it on us.Life After the State - Why We Don't Need Government (2013) is now back in print - with the audiobook here: Audible UK, Audible US, Apple Books. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.theflyingfrisby.com/subscribe

L’anoressia nervosa nei maschi è sottostimata. Questo è quanto evidenzia un nuovo studio pubblicato su Canadian Medical Association Journal che commentiamo a Obiettivo Salute con il prof. Leonardo Mendolicchio, psichiatra, psicoanalista, direttore responsabile della U.O. Riabilitazione dei Disturbi Alimentari e della Nutrizione presso Auxologico Piancavallo, in provincia di Verbania e autore di “Fragili” (Solferino)

Dr Raj Bhardwaj, our CBC medical columnist, says back pain is one of the most common complaints that brings people to the doctor's office.

Selon des données publiées dans le Canadian Medical Association Journal, le nombre de Québécois prêts à faire un don d'organes après avoir bénéficié de l'aide médicale à mourir est en hausse. En 2022, 14% des donneurs d'organes ont opté pour cette intervention.   Entrevue avec Dr. Alain Naud, médecin de famille et médecin en soins palliatifs au CHU de Québec-Université Laval.Pour de l'information concernant l'utilisation de vos données personnelles - https://omnystudio.com/policies/listener/fr

More and more Canadians are unable to access public primary healthcare, according to a study published in the Canadian Medical Association Journal at the beginning of December. In fact, about 20% of Canadians have no family doctor at all, and many more have irregular access to clinicians. The CMAJ study compares the Canadian primary care system with New Zealand and eight countries in Europe including France, Germany, Italy and the UK. Dr Tara Kiran is the senior author of the study and a family physician and scientist at St. Michael's Hospital and the University of Toronto.

A growing number of Canadians are choosing medically-assisted death. Last year, more than 13,000 Canadians used the program — a 31 per cent increase over the year prior. Matt Galloway discusses why more Canadians are choosing medically-assisted death, with Dr. Michel Bureau, the head of Quebec's commission on end-of-life care; and Dr. James Downar, a physician who heads the University of Ottawa's palliative care division, and the co-author of a recent study for the Canadian Medical Association Journal that looked at who gets MAID and why.

HAPPY HALLOWEEN, FRIENDS! This week Your Doctor Friends are doling out TWO episodes of spoooooky stories and hair-raising health headlines! Each episode contains a "sharing size" story with a little "fun-sized" article at the end! Today we start with the (maybe not-so-scientific) connection between the full moon and erratic behavior (if there really is one...). We dive into the origins of this widely-held belief that the full moon triggers weird demeanor, and what the studies suggest may be closer to the truth. At the end Jeremy explains the health benefits of eating actual pumpkin! Stay tuned for another eerie episode this Thursday, November 2nd (the end of the Dia de los Muertos!) for another bag of treats! Happy Healthy Haunting, y'all! Resources for this episode include: A Canadian Medical Association Journal article titled "Bad Moon Rising: the persistent belief in lunar connections to madness." A 1985 Psychological Bulletin journal article by Rotton and Kelly titled "Much ado about the full moon: a meta-analysis of lunar-lunacy research." A study published in the World Journal of Surgery investigating full moons, zodiac signs, and Fridays the 13th and their relationships (or lack thereof) to emergency operations and intraoperative blood loss. A Scientific American article titled "Lunacy and the Full Moon. Does a full moon really trigger strange behavior?" A New York Times article on the health benefits of eating pumpkin! For more episodes, limited edition merch, or to become a Friend of Your Doctor Friends (and more), follow this link! This includes the famous "Advice from the last generation of doctors that inhaled lead" shirt :) Also, CHECK OUT AMAZING HEALTH PODCASTS on The Health Podcast Network   Find us at: Website: yourdoctorfriendspodcast.com  Email: yourdoctorfriendspodcast@gmail.com    Call the DOCLINE on 312-380-5005 and leave us a message. We will listen and maybe even respond/play it on the show!   (Disclaimer: we will not answer specific medical questions or offer medical advice. Consult your healthcare professional with any and all personal health questions.)   Connect with us: @your_doctor_friends (IG) @yourdoctorfriendspodcast1013 (YouTube) @JeremyAllandMD (IG, FB, Twitter) @JuliaBrueneMD (IG) @HealthPodNet (IG)

House doctor Raj Bhardwaj highlights a report published this month in the Canadian Medical Association Journal looked at outcomes related to the change.

A paper published in the Canadian Medical Association Journal is calling for the expansion and further research of using prescription stimulants to treat harm reduction. Guest: Dr. Scott MacDonald - a physician at Providence Health Care's Crosstown Clinic, co-authored the article 

This week on Open Sources Guelph, we're not phoning it in before the long weekend. There are some very serious issues that we need to shed a light on, including that was-it-a-coup-attempt in Russia last weekend that might have changed the game. And speaking of changing the game, is Canada about to be serviced by one big newspaper company? What about the fate of local news? In the back half of the show, nothing major, just the state of our emergency rooms in Canada. This Thursday, June 29, at 5 pm, Scotty Hertz and Adam A. Donaldson will discuss: The Man Who Coup Too Much. Over the weekend, the mercenary Wagner Group marched across Russia towards Moscow in what looked like the opening moves of a coup d'état and then, just as swiftly as it began, Wagner's leader (and former hot dog peddler) Yevgeny Prigozhin decided to call the whole thing off. So what happened? Are we really supposed to believe that Vladimir Putin's favourite puppet Aleksandr Lukashenko brokered a deal? And what happens next on the frontlines in Ukraine? Stop Local. A little more than a week after they cut 1,300 jobs and shuttered bureaus around the world, Bell Media sent a letter to the CRTC asking them to review the requirement to have their local TV stations produce local news. These requirements have existed since the dawn of commercial television, but now Bell thinks that local news is a lemon that they want to get rid of. Following Bill C-18, and the announcement that the Toronto Star maybe merging with Postmedia, can anything save local news? The Old Department. It's been one of the worst kept secrets that emergency departments at Canada's hospitals are in trouble. COVID-19 turbo charged the issues they were facing, and in a post-COVID world, hospitals are dealing with staff burnout coupled with constant high levels of activity that fall outside the normal patterns. Then, last week, Dr. Catherine Varner wrote in the Canadian Medical Association Journal that not only are the problems in Canada's E.R.'s persistent, they're going to continue for the foreseeable future. She's going to tell is all about why. Open Sources is live on CFRU 93.3 fm and cfru.ca at 5 pm on Thursday.

Dr. Andrew Pinto , the lead author of the commentary published in the Canadian Medical Association Journal discusses how collecting race based data is important to address inequities especially in the health care sector.

Guidelines hold great importance in pain medicine. With many interventional procedures, there is some evidence for efficacy, but wide variation in study results due to differences in technique, interpretation, and implementation. In this month's RAPM Focus, Executive Editor Chad Brummett, MD, joins Steven Cohen, MD, the senior author of “Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group,” first published in November 2021 (https://rapm.bmj.com/content/47/1/3). These guidelines are a valuable resource for trainees, fellows, and anyone who works with them. Dr. Steven Cohen is a professor of anesthesiology and critical care medicine, neurology, physical medicine and rehabilitation, and psychiatry and behavioral sciences at the Johns Hopkins School of Medicine and Uniformed Services University of the Health Sciences in Baltimore, MD. He is also chief of pain medicine and director of pain operations at Johns Hopkins and director of pain research at Walter Reed National Military Medical Center. He has published over 400 peer-reviewed articles and book chapters in journals such as Lancet, JAMA, BMJ, Canadian Medical Association Journal, Anesthesiology, Pain, and The New England Journal of Medicine. In addition to his academic work, Dr. Cohen is a retired colonel in the United States Army. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on Twitter @RAPMOnline.

Dr. Kevin Mailo welcomes Alberta-based anesthesiologist and first Indigenous president of the Canadian Medical Association, Dr. Alika Lafontaine, to the show. Dr. Lafontaine talks about the importance of narrative, our personal narratives and the stories shared about medicine and with patients, to create hope and foster well-being. Dr. Alika Lafontaine shares his personal story, some of the struggles he faced with learning and growth in his early years and the ways in which narratives offered to him affected his outlook. He tells about how his parents helped shape him in positive ways and the personal self reflection ability he developed through performing with his siblings. His experiences, good and bad, have shaped how he views medicine and the importance of the stories told within the profession and to each other.  In this episode, Dr. Kevin Mailo and Dr. Alika Lafontaine address the question of what you're willing to sacrifice to the altar of medicine as a physician. They examine how the narrative we have with ourselves influences how we do medicine, and how the narrative we have about medicine influences the experiences we have with patients. Alika shines a light on reframing perspectives and realizing how the narratives we tell ourselves about others contributes to bias and exclusion in treatment. This is a powerful episode about the possibilities of medicine and the vitality of connection with oneself and others through the stories we tell.About Dr. Alika LafontaineDr. Alika Lafontaine is an award-winning physician and the first Indigenous doctor listed in Medical Post's 50 Most Powerful Doctors. He was born and raised in Treaty 4 Territory (Southern Saskatchewan) and has Metis, Oji-Cree and Pacific Islander ancestry.Dr. Lafontaine has served in medical leadership positions for almost two decades. At the Alberta Medical Association, he has served on the representative forum (since 2012), the nominations committee and the Indigenous health committee, and he is a current board member. At the Canadian Medical Association, he has served as an Alberta AGM delegate, has been a member of the appointments committee and has chaired the governance council of the Canadian Medical Association Journal. At the Royal College of Physicians and Surgeons of Canada, he has served on the Indigenous health advisory committee and search/selection subcommittees, he has chaired the regional advisory committee (western provinces) and he is a current council member. He is a member of the board of HealthCareCAN. He has also served as vice-president and president of the Indigenous Physicians Association of Canada.From 2013 to 2017 Dr. Lafontaine co-led the Indigenous Health Alliance project, one of the most ambitious health transformation initiatives in Canadian history. Led politically by Indigenous leadership representing more than 150 First Nations across three provinces, the alliance successfully advocated for $68 million of federal funding for Indigenous health transformation in Saskatchewan, Manitoba and Ontario. He was recognized for his work in the alliance by the Public Policy Forum, where Prime Minister Justin Trudeau presented the award.In 2020, Dr. Lafontaine launched the Safespace Networks project with friendship centres across British Columbia. Safespace provides a safe and anonymous workflow to report and identify patterns of care; patients and providers use the platform to share their own experiences and contribute to system change without the risk of retaliation for sharing their truths.Dr. Lafontaine continues to practice anesthesia in Grande Prairie, where he has lived with his family for the last 10 years.Resources Discussed in this Episode:Save the Date for May 6-7, 2023 in TorontoDr. Alika LafontaineVal Arnault-PelletierDr. Krishna Kumar—Physician Empowerment: website | facebook | linkedin __TranscriptDr. Kevin Mailo: [00:00:01] Hi, I'm Dr. Kevin Mailo and you're listening to the Physician Empowerment Podcast. At Physician Empowerment, we're focused on transforming the lives of Canadian physicians through education in finance, practice transformation, wellness and leadership. After you've listened to today's episode, I encourage you to visit us at PhysEmpowerment.cam- that's P H Y S Empowerment dot ca - to learn more about the many resources we have to help you make that change in your own life, practice and personal finances. Now on to today's episode. Dr. Kevin Mailo: [00:00:35] Hi, I'm Doctor Kevin Mailo, one of the co-hosts of the Physician Empowerment Podcast. And today I'm very, very excited to be bringing on current president of the Canadian Medical Association, Dr. Alika Lafontaine, who is an Alberta-based anesthesiologist who is also our first Indigenous Canadian Medical Association president. And today we've got Alika on the show to talk about the power of narrative in our personal and professional lives as a way of connecting with one another, but even connecting with ourselves. And this is one of the central themes of Physician Empowerment, where, you know, we come together and we talk about our practice journey or our wellness journey or our financial journey, but it's important to discuss, you know, not only, you know, facts and figures, data, but it's important to share our struggles, our failures, our successes and what we learned from those. So with that being said, Alika, why don't you say a few words? Tell us about yourself. Dr. Alika Lafontaine: [00:01:39] Yeah, absolutely. So first off, thanks for inviting me on to the podcast today. I think that the subject of narratives and the stories that we hear and the stories we tell ourselves about medicine is something that has definitely gained greater focus in this year. You know, when you talk about moving people just generally, before getting into my own story, people are moved by where they think they're going, not necessarily where they're at. You know, I think when you talk about why we get stuck is because we get so focused on, you know, what's going on in the moment. But when you talk about really being motivated, when you talk about big system change, when you talk about doing things differently, it's because we get caught up in a narrative that has this imagined, like a better world, a better place, you know, somewhere that we should aspire and you know, work towards getting towards. And that definitely has application in my own life. So when I was young, I grew up in a great family, two parent home, my dad made enough for my mom to stay at home and raise us five kids. We weren't a rich family, but we always had enough food on the table. We had a warm home. Like we didn't go vacation in exotic places, but we had a lot of fun together. Right? And my mom was a first generation immigrant from the island of Tonga. She came to California before meeting my dad and coming up to Saskatchewan. My dad was a Metis kid who grew up in small town Saskatchewan, a place called Lestock. And together they raised a family where we were really taught that, you know, community was super important. You know, respect for oneself and each other was super important, but really, really central to their message of where we could get to if we worked hard was the idea of education. My dad was the first one to go off and get an undergrad and a master's degree in his family. My mom gave up her education dreams and she reminded us, you know, I'm here for you. I've lived my life. Now I'm here to support you. So you need to go off and, you know, achieve that next step so you and your family can continue to have a better and better life. Right? Similar narrative to a lot of things that we've all been taught, you know, in the generation that we grew up in. And I remember in grade school, my teachers were very concerned around, you know, grade three, grade four, grade five about my ability to read. And it wasn't that I couldn't pick up concepts, its that I had a very difficult time expressing myself in a way that they could understand. So I would mispronounce letters. I had a very bad stutter. I think all of these things created a lot of anxiety for me, you know? And as a result, I had a great difficulty reading out loud to teachers. Dr. Alika Lafontaine: [00:04:39] And they did a lot of work to try and figure out what was going on, but eventually reached a point where they sat down with my parents and me and they told my mom and dad, you should plan for him not to graduate high school. He's not going to do anything else with his life. And I remember that moment in the vehicle after my mom was holding me and she was kind of rocking me back and forth. And she was telling me, you know, you're not broken. You're not broken. And that really set into me, you know, this narrative that I told myself growing up, you know, I have to prove to each other that, to other people, that they're wrong about me. You know, I have to live up to, you know, not only the dreams that my mom had, but also I have to, like, prove to myself that I'm not broken. Right? And, you know, my parents, to their credit, they put a lot of time into me. My mom doubled down with kind of taking care of us at home by, you know, becoming a teacher for me and home school. You know, eventually my younger siblings were pulled out of school so we could all do home school together, which I think was was really positive for me. So my two older brothers continued on to high school, but me and my younger siblings, we all took home school together. My dad went off and he had been trained as a teacher. He had gone to law school for a little bit, went off and did his master's in educational administration. So he went down to the States and got some extra training in different learning techniques, whether it's a mix of what they did or whether I grew out of it or whether it was, you know, addressing ear infections that I had when I was a kid, for whatever reason, I started to turn a corner. And it was interesting because I was labeled as learning disabled. So a learning delay with a speech impediment when I was younger, and a few years later I was labeled as gifted. And so now suddenly I had a completely different narrative that was going on in my life. And you know, that really propelled me, I think, through a lot of the frustrations that we all go through when we're trying to get into medicine and, you know, going through med school and other things. You know, what is it that drives you to, you know, do what you do? And obviously, I had the same sorts of things that I wanted, that a lot of people that come into medicine want, where we want to help people, we want to have a life of meaning, you know, these other things. But there was the added motivation that I had that I had to prove myself, right? Dr. Alika Lafontaine: [00:07:09] And I think those things together, you know, not just having my own life story, but also sharing a lot of the stories that we all have when we come into medicine, it made me particularly sensitive to burn out this belief that I had to be everything to everyone. This intense disappointment when I didn't succeed. I remember in my first year of medicine getting a, I think it was like a 74 on a histology exam, average person they're like, oh, 74 that's probably not a big deal. I thought my my life was over. I went over to the histology professor and I asked them for extra tutoring help. And I remember that whole first few weeks just really feeling out of place. I was meeting these kids who came from multigenerational physician families, people that were fairly well off. I was the only Indigenous kid in all four years at the time. And the teacher, instead of reassuring me, said, You know, it's probably not the end of the world if you don't pass first year and repeat it. And kind of waving me away and I remember walking out of that room and saying to myself, I'm done, I'm done med school, I'm not going to continue on in a place that I don't feel like I belong and I'm not going to be able to succeed. And I walked down that hallway and I met Val Arnault-Pelletier, she's a current lead for the Indigenous program over at University of Saskatchewan right now. So she's been there for a very long time, helping many, many kids like me get through the challenges that I know I shared with many, many people. And, you know, she really helped me along with many, many coffees with the dean over the next four years to help me tell a different story to myself that it was okay not to always be perfect in every situation and that there was a lot of learning and growing that had to go through and I had to give myself space to do that, you know. So my life's interesting in retrospect now because I can see how the very negative narratives that I was taught were both heartbreaking but also motivating. But then the very things that brought me into med school were the very things that broke me early on in med school as well, you know. And so I've learned different stories about myself over and over again over my career. I continue to learn different stories about myself. And I think when we talk about telling stories, it's not only about stories that sweep other people up in movements to create a better type of health care system. It's also stories that we can believe, so we can thrive, so we can address a changing world around us in a way that's maybe a lot more healthy than we did before. Dr. Kevin Mailo: [00:10:05] Yeah, that's so powerful. I mean, I think what you're touching on is what perception can do in our lives, right? I mean, you know, the same events occur to us, but our perception changes our experience of that set of events in a given moment in our lives. So before we get to, you know, our relation to other people in narrative and storytelling, I like the word storytelling. How do you look inward? What does that process look like for you? Because I think everybody's a little bit different. You know, some people will go take a vacation by themselves. I drive with the radio off in my truck for a few moments here and there and just reflect or people will meditate. But what does connecting with our own narrative look like for you, and looking inward look like for you? Dr. Alika Lafontaine: [00:10:56] It's interesting how you have a lot of experiences that seem very disconnected over your life. But then when you end up doing something really meaningful, it seems like everything kind of converges into a single point, right? And you realize, hey, that thing that I thought was very different than what I ended up doing maybe is at the core of why I do what I do well. Right? So another thing my mom really encouraged us to do when we were young was to sing together, I was actually part of a boy band for like two decades, right? It was, it was me and my five, the five of us siblings, like touring across Saskatchewan, Manitoba, Alberta. Eventually it was Canada-wide, we toured parts of the US and performed in the Pacific Islands and things. But over those two decades of performing, you start to get a real sense for feeling the emotions of the people that you perform for, but then becoming hyper aware of your own feelings. Because if you're not, you actually can't give a good performance. Dr. Kevin Mailo: [00:11:53] Wow. Yeah. Dr. Alika Lafontaine: [00:11:54] And so, I, over the years of performing with my family, really had a lot of opportunity to verbalize the way that I was feeling, reflect on how I was feeling, you know, inject that into this performance piece. So we were vocalists, like it was an R&B kind of pop group. We wrote our own music. We published three albums over the time that we were performing. This was all before YouTube, so you're not going to find a whole lot of stuff on us online. Dr. Kevin Mailo: [00:12:25] So I can't just look you up on TikTok. Dr. Alika Lafontaine: [00:12:27] No, no, you can't look me up on TikTok. But we ended up doing some pretty big shows. Like when EPTN opened, we were part of kind of the opening set, we opened for Susan Aglukark, I think was right after us. We were on the Inspire Awards, which back then was called the National Aboriginal Achievement Awards. So that had viewership of like 2, 3 million people across the country. So I had a lot of opportunity to self-reflect and understand why I did the things that I did. Now you can obviously be educated about something but not be able to, in the moment, manage yourself. So I mean this isn't to say was like a philosopher at the time of being in med school, but I did have tools available to me to understand myself. And some experiences where I could sit back and say to myself, Well, this is what we did when we wrote this song. This is what we did when we prepared for this set. So maybe I'll sit down and kind of figure out exactly where my head is at with all of this. And I think when you're looking at yourself, there's two parts that I found really, really useful. And it's different for everybody, but two things that I've found really useful. The first is being brutally honest with yourself about how you're feeling in the moment. Dr. Kevin Mailo: [00:13:35] Wow. Yeah. Dr. Alika Lafontaine: [00:13:37] You know, it doesn't make a ton of sense to deny yourself the reality that, hey, I'm sad, I'm happy, like all this other stuff. And then the second part is linking that and understanding how the things you experience trigger those emotions and put you into different cycles. Right? And I get caught up in them just the same as everyone else. I mean, we all know that there's unhealthy habits that we get into once we get into heavy call, right? I mean, you're up at 3 am, you had a horrible night, maybe in extremely horrible nights you had bad patient outcomes or some sort of disagreement with a colleague or other things. There are natural like things that we reach out for whenever we're feeling like that. Right? And so being able to understand those two parts of myself, I think has been really helpful. And I think when you're looking at how do you bridge, how you feel about yourself to now interacting with the world, it's negotiating with yourself about what exactly you're going to give the world to bring the world to that point where it can give you what you're looking for. I had a physician that did research projects under when I was a medical student. His name was Krishna Kumar. He was a neurosurgeon in Regina. And, you know, consistent with my story, I picked the hardest thing I could think of once I got into med school as far as what I was going to go after, as far as, you know, residency and is this true or not? I'm not really sure. But 19 year old me thought that this was what what I should chase after. So I wanted to do neurosurgery. And so I followed around Dr. Kumar for a couple of years. And this guy, I mean you won't find a harder working physician anywhere. 16 hour days, 12 hour surgery standing up, working on Saturdays and Sundays, flying around the world, doing presentations. He had the largest research body for spinal cord stimulation, I believe in the in the world at the time that I worked with him. So I kind of fell in this opportunity with this amazing physician. And I really poured my heart and soul into it for the first, like year and a half, showing up his house at 2 am to do presentations, being available any time of the day to to sit down and do different things, following around inside the OR and other places. But he noticed halfway through my second summer, I became a little disinterested in what was going on. And at that time I'd actually met my now wife, and I remember him sitting down with me over lunch and he had this thing where he'd like, peel radishes and like, give you slices as he was eating. And he's like giving me these radish slices as we're chatting. Dr. Kevin Mailo: [00:16:21] It's funny how we remember... Dr. Alika Lafontaine: [00:16:22] Oh, yeah, totally. Dr. Kevin Mailo: [00:16:23] .. those things in the moment, right? Yeah. Dr. Alika Lafontaine: [00:16:26] Yeah, sense and sounds. And I still remember how he looked and and all that stuff. And he's, he's chatting with me about work and then he makes a turn in the conversation, asking, like what's going on. You know, you seem just a little bit distracted, was the word that he said. And I told him about this amazing girl that I'd met. And I'm sorry if it seems like I'm not paying as much attention, she's just really incredible and all this other stuff. And Dr. Kumar was not an emotional guy, right? He was a warm guy, don't get me wrong, but he was very business. Right? And I noticed a softening that came over him. He reached his hand out onto my shoulder. He wasn't big for physical contact, but it was like a very, like fatherly touch. Dr. Kevin Mailo: [00:17:11] It meant something. Dr. Alika Lafontaine: [00:17:12] It totally meant something. And he leaned in and he said, you know, Alika, don't sacrifice your life on the altar of medicine. It's not worth it. And then we went back to talking and, you know, it never came up again. And I look back at that moment as really formative for me. I don't think I realized just how much it impacted me until later. But you have this person who, world leader in what he does, sacrifices almost all of his life to medicine, raised a beautiful family, had a good relationship with his wife and kids, but he missed out on a lot of important events in his family's life because he was focused on creating those moments for other folks who were sick and otherwise. And, you know, he's telling me, don't sacrifice too much. You know what I mean? And so it's interesting when you think about the stories we tell ourselves about our contribution to medicine and how much we need to give and all these other things. And the reflection of someone like him at the waning years of his life that maybe what we think we're getting out of medicine isn't really worth the amount that we think we're getting out. Dr. Kevin Mailo: [00:18:29] I think that's very powerful. And, you know, my own reflection on that is that we can give the health care system, our communities, our best when we are at our best. And part of that process involves self rejuvenation and having a notion of self outside of the profession because it's, I think, very easy for medicine to become quite consuming to the point that you look in the mirror and you say, Well, I'm such and such type of doctor. Right? Or our credentials. But the real us is so much more. It's all the way back to those formative years in our childhood, even the inner child, if you want to call it that, but our relationships with the others, but even with ourselves. And that's a very powerful observation. So how do you set that balance then, Alika, of, you know, the professional self and the personal self? And that's a concept we actually talk about at our wellness events, is the notion of different selves, that there's a financial self, a personal self, a professional self. How do you find that balance between personal and professional self? Dr. Alika Lafontaine: [00:19:34] So as someone who has been both balanced and unbalanced throughout my life, I think the first thing to recognize is that there will be times when you'll be completely unbalanced. Right? So this year, as president of the Canadian Medical Association, has been all consuming. And it's just the nature of, you know, the value add that I want to provide to colleagues across the country, but also just the nature of the work. Right? Residency is all consuming, right? Early practice, to some degree, can be very all consuming. The first time you take a leadership position as, you know, someone in your department contributing or elsewhere, it can be all consuming for a period of time. Right? And so I think that there's times and seasons to everything. And just to be aware that balance 100% of the time is probably not, it's not the accurate way of describing it. Dr. Kevin Mailo: [00:20:32] It's very hard to do. Dr. Alika Lafontaine: [00:20:34] The way that we work. Yeah, yeah, the way that we work in medicine. So I think the goal is to work towards balance and at times achieve it, but then recognize that from time to time it's unbalanced and just own those moments, right? And if it's too unbalanced, reorganize your life so it becomes less unbalanced, but it will remain unbalanced from time to time. Right? So that's kind of the first part. I think the second part is that when we look back, so I'm a big student of history, right? So I think one of the best ways for us to understand where we're going is to know where we came from. And if you look at the medical system and what a lot of us would refer to as very unbalanced practice patterns, I think the world has changed a lot from the times of folks that we train under who've been practicing for, you know, 40, 45 years. Right? If you go back even 20, 25 years, a physician in a community was at the center of a lot of the work in the community. Right? When you volunteered at the hospital, you were also volunteering at your community. There wasn't a division between the two things, right? You could especially see this in small town Canada, where your doctor was also someone who interacted pretty closely with the Parents Council, the community association, you know, the mayor's office, like all these things. Dr. Kevin Mailo: [00:21:56] Like people look to you. Dr. Alika Lafontaine: [00:21:57] People look to the doctor or doctors as part of building up the community. Now, since that time, that's shifted, right? And so we introduced these new divisions into the way that society interacted, but we didn't update the way that we saw ourselves. And so there was a turn in the late 90 seconds, early 2000, where there was like this value extraction, for lack of a better word, that occurred where people leaned into this narrative that we had that we were willing to sacrifice on the altar of medicine in order to get, you know, meaning out. But that meaning increasingly disappeared from the practice of medicine. You know, we still had those moments where we really connected with patients. I mean, I've had lots of experiences that I mean I'll always treasure that I've had with patients, both good and bad. But the job itself become became much less of a place where you could you could wear dual hats at the same time, you know, be a part of the community, be a part of your family, be a part of, you know, work. Right? And I think that value extraction has continued up until today and it accelerated, I think, in the last five years. And it wasn't until COVID came along that I think a lot of us sat back and realized just what was happening. We were moving too fast. Dr. Kevin Mailo: [00:23:25] No question. I mean, there's no limit to what this career can ask of us as individuals. Truthfully, there is no limit. Dr. Alika Lafontaine: [00:23:34] Yeah, Yeah. And so with that pause that COVID gave us and that opportunity to reevaluate what was important, and I think it was a moment where we, a lot of us honestly sat there and said, Do I want to live and die for this? I remember March of 2020 coming back from a canceled leadership gathering because of this unknown virus that was floating around. Touching down, going into work, we started putting masks on patients who were coming down from the floor. We started continuous masking. We were told we're going to run out of masks if we, you know, continue to do this. We're going to run out of protective equipment. And so there was strong efforts to really, really slow down the utilization of this, which to many of us, we felt like there was no protection. Dr. Kevin Mailo: [00:24:24] Yeah, there were those moments. Absolutely. Absolutely. Dr. Alika Lafontaine: [00:24:27] Yeah, yeah, yeah, absolutely. And so I remember coming home from work that, the second night that I had been back, and sleeping in the garage. And I actually slept in the garage for like the next three, four weeks. I know many of my colleagues that slept in the, because you didn't want to get your family sick. Dr. Kevin Mailo: [00:24:44] You didn't know. And that's when it becomes so real. What we might be asked to give up. Dr. Alika Lafontaine: [00:24:52] Yeah. And I think a lot of us sat there for the first time in our careers. I mean, we always knew it in the back of our minds that it could be possible. But we were actually confronted with that moment of if someone was dying in front of you and you could get infected, were you willing to die for that patient and were you willing to potentially make people that you loved very sick and potentially die as well. You know, it's, I think it's easier right now to look back and, you know, say to ourselves, well, we know this now and all these other things. And I think pre-vaccine, it obviously was a completely different game. You know, we didn't have what we have now. But I really think in that moment, a lot of us realized for the first time, I don't, I think there's a line to what I'm willing to give. You know, and I know for myself, I never actually defined a line of how far I'd go in order to, you know, sacrifice for the health care system. And I think that was the beginning of me realizing I really do need to make sure that the most meaningful parts of my life are protected. And that I can find a way forward to separate, you know, the story I tell myself about the doctor that I want to be and the kind of person I want to be in the rest of my life. And I see that that conversation going on in the minds of a lot of colleagues across the country still. Dr. Kevin Mailo: [00:26:16] And I think you're absolutely right what a powerful experience the pandemic was, because in that, in those moments, you know, we're worried about catching the virus, getting sick or getting a loved one sick. You know, it crystallized that reality of what medicine asks of us, but in reality, day to day, medicine is chipping away at us or some of us in terms of our health and well-being or our relationships. Right? You know, when you're, you know, you're working those long hours or you're constantly on call, you're constantly exhausted, you're constantly tired, how present are you for the people in your life? How present are you for yourself, for your own wellness? And, you know, it's just those those things aren't so explicit because we say, well, it's just one more night shift or it's just, you know, one more week of call and I'll be off for a few days or whatever. Right? But in reality, these are big asks of us in terms of our well-being. And we just don't necessarily recognize them because they're built into the culture of medicine. Like you said. You know, it's begun sort of, it's ubiquitous. Dr. Alika Lafontaine: [00:27:25] And sometimes it's pretty striking things that in the moment you think are so normal, but in retrospect, you're like, wow, that was really abnormal. I mean, I remember in residency knowing that at 72 hours of no sleeping, I would just kind of collapse on the floor and fall asleep. Right? And I know that it happened multiple times. Like I'd, I would push myself past what I could do and then keep on going. And I'd go home at the end of the day and I'd wake up on the floor at like 1 am and young kids and my wife had just kind of, step over, let me sleep there. They put a pillow under my head and threw a blanket on me. But, like, they they knew that it was more disruptive to try and wake me up and get me to bed than it was just to let me lay there. And I just thought it was something that everyone just did. And then you get out into the real world where you're not interacting with just doctors anymore and you realize that that's not normal at all. Dr. Kevin Mailo: [00:28:24] So talking about narrative, we talk about relating to ourselves and connecting to our self with our own stories. And I thought this was so powerful to go back through the decades of your life and see those moments, like you said, like cutting what was it, radishes on a kitchen counter, you know, in the middle of the night. And so talk to us about narrative as it relates to one another professionally. Right? And talk about, you know, how narrative relates to our patient encounters. Because I think there's a lot of beauty there. Dr. Alika Lafontaine: [00:28:54] Yeah, absolutely. And we we've talked so far a lot about, you know, our personal narrative that we have with each other or with ourselves. And then we we talked a bit about that value exchange that goes on between us and kind of the broader narrative of what is medicine and what does medicine expect of us? I think when we're interacting with each other, there's the narratives that we also tell ourselves about what other people think about us and how they interpret what we do. And then there's also narratives that we project onto other folks, you know, so I've obviously done quite a bit of work in the area of equity, diversity, inclusion, anti-racism, etcetera. And part of the way that I now explain things has come from my own feeling about performing and audiences. You know, I think people to a great degree are always well meaning. And they're being taken on this emotional journey that they may or may not be consciously aware of. That's not to say that unconscious bias is what drives inequity and exclusion and racism, etcetera. But it helps to frame things in a way that people can plug into emotionally instead of just telling them that you're like a bad person, right? The worst, the worst feeling I think for a physician is to be told after 36 hours of being on call that you don't care about patients. Dr. Kevin Mailo: [00:30:22] Exactly. Nobody's going to work trying to screw up here. Dr. Alika Lafontaine: [00:30:25] Yeah, 100%. And I think if you take that as a starting point for the majority of people, that's a place that you can have people come together more easily than other places. It also gives someone the opportunity to be more harsh with themselves than you are with them. Because the truth is, if people want to change and recognize that they're creating bad experiences for those around them and potentially harm, you know, because sometimes the decisions that we make, because of bias and other things, actually do create harm. If you want people to be introspective and actually change, they're going to be way more harsh with themselves than you could ever be. Right? And so that's kind of the first point. The second point is that we're often swept up by these things because the ways that we thought about things kind of worked. You know, even going back to what I was talking about with physicians who sacrificed their life and, you know, spent all their time at the hospital, you know, 25, 30 years ago, it worked for them. They were still able to see their family. They were still able to be a part of the community and all these things. But the world changed, right? And I think that that's the same case with a lot of the stories that we project on to other people. At some point that story made sense, right? At some point that story was true. But it's whether or not in that moment, is that story true? Is that story adaptive? And I think increasingly people are realizing that stories that tend to be pretty prevalent can lead to significant, you know, harm and pain for folks and especially patients. So one of the things that I've had the chance to be an advocate for and, you know, participate to some degree as president is, like, in the area of forced sterilizations for Indigenous women. And I and I remember as a resident, that there were situations where, you know, the surgeon would lean over, your patient would be under a spinal like doing a C-section or whatever, and they'd say, okay, I'm going to clip your tubes. And then a tear would roll down their face. And in the moment, I would sit there and think to myself, Oh, my spinal must not be working. So then I'd go grab the ice, I'd like check whether or not things are moving around, I'd peek over and see whether or not they externalized the uterus, which can sometimes cause referred pain up into the shoulder. It just never crossed my mind that they did not feel that they had a conversation where they were fully informed that this was happening. And in retrospect, it's easy for me to see what could have happened. Right? But I think for a lot of folks who are currently practicing, if you want to understand how to be a better physician, you have to be open to, you know, reframing what you thought you were doing and how you thought you were affecting other people and why people were reacting in the way that they did to you, into a way where you give some space, Hey, maybe I just didn't see what was going on. Maybe I actually was, you know, I don't think a lot of folks realize just how how hurtful it is when you meet, you know, an Indigenous person with a traditional name and you don't even try and pronounce it. So some folks, yeah, and people think, well, I'm being respectful, right? When in reality, like, it's very, very hurtful. Right? But you wouldn't know that unless you actually were able to talk to someone about it. That's not something that's a classic narrative that you would pick up just from day to day life. And so, you know, I think when we talk about patients and each other and other things, we have to get to the point where we can talk about the stories that that we believe and project on to other folks and also hear them tell us what are they feeling. Dr. Alika Lafontaine: [00:34:07] And I do feel that we we should celebrate to some degree that we are in a place where we can say racism out loud, sexism out loud, discrimination out loud. And I do hope as we continue to move forward, we'll start to realize that the goal is not to get rid of everyone who has those those thoughts or those feelings, because that's kind of a part of the world that we grew in, grew up in. Right? Those are the stories that we heard and adopted. But instead try and help people not to, you know, mindlessly act in a way that's harmful to other folks. Like that, I think, is the actual end point. Because when you when you talk to patients about, you know, racism, what do they want? They just want the harm to stop. Right? They don't necessarily need, you know, every racist thought or other things to be eliminated from the provider's mind. What they actually want is for the actions to stop. And I think if we approach it from that point of view, it's a very different, it's a very different problem. It's a much more achievable problem. Solvable problem. Dr. Kevin Mailo: [00:35:10] But I think it's so powerful when we hear the stories of what patients have experienced going through our healthcare system with systemic racism or sexism and hearing the stories on an individual level, like the case of that patient having her tubal ligation really with no with no discussion or consent. Proper consent at least. And so those are the kinds of things that can be very powerful to motivate us, to help us to see things from another's perspective. Dr. Alika Lafontaine: [00:35:44] And I think that that brings us closer to what we actually want to get out of medicine. And this goes back to like the the the the altar analogy, is not that we can't get meaning out of medicine, it's just that the world has changed. So we have to change too, like our meaning has to change. You know, the way that we get it has to change. And I think at the very beginning of all of this, like you talked a lot about, or you mentioned burnout and the need for wellness and, you know, having people step back and realize there's different parts of who they are and what their needs are and and other things. And 20, 30 years ago, we wouldn't talk about that. Right? And I think today we have to confront it because that's a necessary part of the new story we have to tell ourselves so we can start to thrive in medicine again. Dr. Kevin Mailo: [00:36:25] And I think it's important to use, you know, storytelling and shared experiences to humanize medicine because too often I think we look at it from a very technical perspective. I mean, you know, you come into the emergency department and you're there to, for instance, you know, on shift and you're there to say, Oh, you're not having a heart attack. You rule out anything serious, but maybe that patient's having chest pain because you need someone to talk to. You know, that they're struggling with anxiety or depression and it's presenting, you know. But when we don't create that space to hear people's stories, we end up being very technical. But there's a downside. It's not only, you know, that the patient has lost out, but so have we, because some of the most meaningful moments in my practice have been when I actually just sit and listen to a patient. As we humanize the experience in medicine and humanize our interactions not only with our patients but with one another, I think we feel more connected to our jobs and we derive more meaning from it and we do better care. Dr. Alika Lafontaine: [00:37:26] And, you know, this has me thinking about, you know, something that that's come up over and over again with with being president of the CMA, and that's how do you get unity within the profession towards things that will not just help us, but also help patients. Right? And my mind over the past year has gone back a lot to this whole idea of social cohesion. You know, this idea that we're, we have shared values, we have shared problems, and we find shared solutions together. And I think increasingly, what's the number one challenge of patients across the country? It's access. It doesn't matter which part of the ideological spectrum you're, right, how much you think government should be involved or not involved in your life. You know, if you're sick, you want access to care. You want access to to people that, access for people that you care about. And the polarization that we have, I think, has introduced this idea that somehow we'll get that access if we're right, if only people would do our solution, you know, everything would work out. When in reality, I think the way that we improve access is to improve cohesion within the health care system and between like the people that provide us care and the people who are coming for care. If you don't feel united with your provider, you're not going to share with them what's actually on your mind. If you don't work in a team where you feel like you can lean on them, you're not going to be able to find those moments where you can create additional time that you didn't have the day before because now you're working with the team that you're working well with, right? Dr. Kevin Mailo: [00:38:55] Absolutely. Absolutely. It's so true. I mean, just again, it's that shared experience, not that we have to agree on everything, but like access will improve when we identify it as the key, key priority that we need to address in our health care system currently. So, Alika, this has been absolutely outstanding and we would love to get you back on the show. Right? Just to hear more of your experience, you know, more of your wisdom in this space. But we would love to hear your final thoughts on what narratives meant in your life and how we can use it in our day to day. Because I think it's important to have medical education meetings, programing that's based around narrative. But I also think it's important that we can integrate narrative into our day to day interactions with patients, allied health and even one another, because I think that binds us together. I think that's cohesion, as you talk about. But practically speaking, how can we integrate, how can we integrate this into our day to day practice lives or our leadership roles? Dr. Alika Lafontaine: [00:39:59] Yeah so I'll maybe just touch on one thing, and that's the importance of narratives driving emotion. You know, why do we believe different stories is because we think we're going to feel different ways, right? And that was a lesson I learned from performing. You know, people didn't come to listen to you sing they didn't come to see you, they came because they thought they were going to get a feeling out of them showing up. And I would say in the moment that we're in right now, there's a lot of hopelessness that's going on. And the reason why people are drawing back from clinical practice, why they're leaving for other things, is because they think if I sit still and continue doing what I'm doing, this hopelessness will continue to build. Right? And so when we talk about the stories we tell ourselves, it's really important to find hope in the hopelessness and to ensure people act in a way that can actually generate hope again. You know, and so that's one part of of the point. The second part is that hopelessness, I think, transitions at some point into indifference. You know, you can see it with certain patient interactions that you had, you know, coming across folks who show up because they're going to die otherwise. But they really have no hope that the system is going to help them. Right? They come in very indifferent. You know, you're just going to be like every other physician, every other health provider that I've ever met who hasn't been able to actually help me get out of this hopelessness. And that is a much more difficult problem to confront. Indifference is many magnitudes worse than hopelessness, regardless of how bad it feels, right? Dr. Kevin Mailo: [00:41:42] Yeah, that's a very powerful observation. Dr. Alika Lafontaine: [00:41:44] Yeah, and so we have a moment right now where we can really focus on doing things that will generate hope. I mean, you look at what's going to happen with the budget later on this month. I do honestly feel that there are going to be some very significant changes in the way that we collect data. The fact that we're going to share depersonalized data between jurisdictions now. We haven't really done that except in huge emergencies like having a unique patient identifier across the country means you now can compare all databases, I mean there's all these different things. The regional license opening up on May the 1st in Atlantic Canada, you know, finally taking a measurable step towards having folks be able to register once for a license and be able to practice in multiple jurisdictions simultaneously. That could transform practice in a lot of different ways. Suddenly, you meet somebody at a conference and you know that you all share a regional license. You could set up a virtual team together the next day. You know, you wouldn't have to worry, how am I going to practice if you move from, you know, a place like New Brunswick to Nova Scotia for school, for example, you know, you could keep your family doc. Because now your family doc's licensed to work in Nova Scotia, they can follow you where you go. You know, there's all these like, really amazing changes that could happen. But we haven't done the greatest job in helping people understand the hope in those actions. Dr. Kevin Mailo: [00:43:07] Right, Right. The emotion that sits there. Dr. Alika Lafontaine: [00:43:10] Yeah, 100%. And so, I think if we can focus on being authentic, because I think false hope is almost worse than remaining hopeless, you know, but we can take people to places where things are very likely to actually change practice, you know, actually make things better. It's important that we all kind of lean in and do that right now because once we start to become indifferent and once indifferent starts to spread and entrench itself across the health care system, it's going to be even harder to change things. Dr. Kevin Mailo: [00:43:44] Absolutely. Absolutely. All right. I think we should wrap it up. But this was outstanding. It was just great. And I really want to sincerely thank you for your time, Alika, because I know you're busy. And on behalf of the profession, and I know you get a lot of thanks, I just want to share another thanks for all you've done to advocate for the profession, but also, again, you know, to advocate for Indigenous voices within our health care system to start meaningful, meaningful change towards one of the most marginalized groups in our society. So, again, thank you. And, you know, we should have you on the show for sure at another point. Dr. Alika Lafontaine: [00:44:23] All right. Thanks for having me. Dr. Kevin Mailo: [00:44:29] Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five star rating and review. If you've got feedback, questions or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at KMailo@PhysEmpowerment.ca. Thank you again for listening. Bye. 

The popular narrative about newer cohorts of family physicians working less than their predecessors is disputed by data published in 2022. In this Third Rail edition of the CFP Podcast, Dr Sarah Fraser interviews Dr Ruth Lavergne, a researcher at Dalhousie University, about her findings and ideas for strengthening primary care—which include supporting longitudinal care, addressing administrative workloads, and moving away from the unhelpful focus on generational differences. Read Dr Lavergne's research article in the Canadian Medical Association Journal at https://www.cmaj.ca/content/194/48/E1639.   

Why it's important to use exercise for optional bone, muscle, and joint health. If you are using exercise for just fat loss alone, hopefully, this podcast will help you change your mindset to start choosing an exercise program that your 80-year-old self will thank you for!   References:  Exercise and physical activity – your everyday guide from the National Institute on Aging, National Institute on Aging, USA.  Aging changes in the bones – muscles – joints, University of Maryland Medical Center, USA.  The benefits of exercise, Centre for Physical Activity in Ageing, Royal Adelaide Hospital Health Services, South Australian Government. More information here.  Warburton, DER, Nicol CW, Bredin SSD 2006, ‘Health benefits of physical activity: the evidence', Canadian Medical Association Journal, vol. 174, no. 6, pp. 801–809. More information here.  Nelson ME, Rejeski WJ, Blair SN et al, 2007, ‘Physical activity and public health in older adults: Recommendation from the American College of Sports Medicine and the American Heart Association', Med Science Sports Exercise, vol. 39, no. 8, pp. 1435–1445. More information here.  Active for later life: Promoting physical activity with older people, British Heart Foundation National Centre for Physical Activity and Health, UK.

The idea wasn't to bust myths. But it seems they have. Teams of researchers across the country wanted to see if family physicians from different generations practise medicine differently. And Dr. Ruth Lavergne says she was surprised to find out the simple answer is there's very little difference. She is an associate professor in Dalhousie's Department of Family Medicine and a Canada Research Chair in Primary Care. As co-author of this study, they found there are similar issues affecting primary care across Canada and the practice followed a pattern. The number of visits peaked for physicians with 27 to 29 years of practice, whereas doctors earlier in practice or at the end of their careers had fewer patient visits. We also discuss fee-for-service, virtual and collaborative care as ways to address the challenges to accessing primary care. The study was published this week in the Canadian Medical Association Journal.

The resurgence of RSV is a situation several Canadian scientists warned about in a commentary published over a year ago in the Canadian Medical Association Journal. Dr. Joanne Langley was one of the authors, she's a pediatric infectious disease physician at the IWK Health Centre and a Professor in the Department of Pediatrics in the Faculty of Medicine at Dalhousie University.

Nova Scotian nurse Keisha Jeffries recently had her research published in a special edition of the Canadian Medical Association Journal, which focuses on Black health. Her study explored the experiences of African Nova Scotian nurses, particularly around leadership in the sector.

A conversation with the researcher behind a recent article published in the Canadian Medical Association Journal called "Gaslighting in academic medicine: where anti-Black racism lives." Dr. Gaynor Watson-Creed explains how gaslighting perpetuates anti-Black racism in medicine.

Keisha Jeffries recently had her PhD research published in a special edition of the Canadian Medical Association Journal, which focused on Black health. The study documents the experiences of African Nova Scotian nurses, their barriers to entering the profession, and their experiences of leadership.

Systemic racism and the Canadian Medical Association Journal. We talk to the director of the Black Health Equity Lab about two new medical journal issues that address this long-standing problem. (Anthony Germain with Notisha Massaquoi)

Courtney Bates-Hardy is the author of House of Mystery (2016) and a chapbook titled Sea Foam (JackPine Press, 2013). Her poems have appeared in a variety of publications, including Room, CAROUSEL, Juniper, This Magazine, and the Canadian Medical Association Journal. They have also been anthologized in Imaginarium 4: The Best Canadian Speculative Writing and The Best Canadian Poetry 2021 (Biblioasis). She is queer and disabled, and one-third of a writing group called The Pain Poets. She is currently working on her second manuscript of poetry, tentatively titled Anatomical Venus. You can follow Courtney on Twitter. As always, we would love to hear from you. Have you tried sending me a message on the Eh Poetry Podcast page yet? Either way, we would like to reward you for checking out these episode notes with a special limited time coupon for 15% off your next purchase of Mary's Brigadeiro's amazing chocolate, simply use the code "ehpoetrypodcast" on the checkout page of your order. If you are a poet in Canada and are interested in hearing your poem on Eh Poetry, please feel free to send me an email: jason.e.coombs[at]gmail[dot]com Eh Poetry Podcast Music by ComaStudio from Pixabay --- Send in a voice message: https://anchor.fm/ehpoetrypodcast/message

This week we got to peek behind the curtains of academic publishing with Wendy Carroll. Wendy is the Managing Editor of the Canadian Medical Association Journal group. Wendy had some amazing insights into the whole process of what goes on with the submission process as well as the overall landscape for journals in 2022. Perhaps our favorite part of our conversation with Wendy was her tips about what makes for good writing! Links: 1. Eight Step editing: https://www.editors.ca/eight-step-editing-jim-taylor-0 2. Predatory publishing solicitation: a review of a single surgeon's inbox and implications for information technology resources at an organizational level. https://pubmed.ncbi.nlm.nih.gov/34105930/

Are the unvaccinated a threat to those who've been jabbed? A recent paper in the Canadian Medical Association Journal is creating a storm of controversy for making that claim amid criticisms of methodological flaws fuelling a major debate. Dr. Byram Bridle and Dr. Denis Rancourt join Trish to ponder a paper some say goes too far. Support Trish on Patreon Find her on Twitter

Lydia Kang is an author of young adult fiction, adult fiction and non-fiction, and poetry. She graduated from Columbia University and New York University School of Medicine, completing her residency and chief residency at Bellevue Hospital in New York City. She is a practicing physician who has gained a reputation for helping fellow writers achieve medical accuracy in fiction. Her poetry and non-fiction have been published in JAMA, The Annals of Internal Medicine, Canadian Medical Association Journal, Journal of General Internal Medicine, and Great Weather for Media. She believes in science and knocking on wood, and currently lives in Omaha with her husband and three children.This episode includes a brief mention of a fictional character's suicide. If you or someone you know needs help, contact the National Suicide Prevention Lifeline at 800-273-8255.

Could annual dramatic shifts in day/night patterns in the Arctic have an effect on seizures? One researcher went looking for answers – and found more than he bargained for. His research revealed a public health crisis in one of the wealthiest countries in the world, highlighting the needs of geographically isolated communities and Indigenous peoples. (He also found intriguing results to his original question.)  Dr. Marcus Ng reviewed 11 years of data on emergency evacuations from the Kivalliq region of northern Canada. There, anyone who has seizures that last more than 5 minutes - an emergency condition known as status epilepticus - is helicoptered to a single hospital in Winnipeg, Manitoba. Dr. Ng wondered if the frequency of evacuations changed as the seasons changed. Were people more likely to have seizures in the 24-hour darkness of winter, the 24-hour daylight of summer, or somewhere in between? He found that the people of the Kivalliq region had the highest reported incidence of status epilepticus in the world, far higher than Canada's overall estimates. His research also revealed the barriers to timely care faced by this population.  This episode was reported and produced by Nancy Volkers. Sharp Waves content is meant for informational purposes only and not as medical or clinical advice. The International League Against Epilepsy is the world's preeminent association of health professionals and scientists, working toward a world where no person's life is limited by epilepsy. Visit us on Facebook, Twitter, and Instagram.  Studies mentioned or used as sources of information:  Status epilepticus in the Canadian Arctic: A public health imperative hidden in plain sight. Epilepsia Open 2021Circannual incidence of seizure evacuations from the Canadian Arctic. Epilepsy & Behavior 2022 Incidence of the different stages of status epilepticus in Eastern Finland: A population-based study. Epilepsy & Behavior 2019 Addressing provider turnover to improve health outcomes in Nunavut. Canadian Medical Association Journal 2019 Contact ILAE with feedback or episode ideas at podcast@ilae.org Support the showSharp Waves episodes are meant for informational purposes only, and not as clinical or medical advice.The International League Against Epilepsy is the world's preeminent association of health professionals and scientists, working toward a world where no person's life is limited by epilepsy. Visit us on Facebook, Twitter, and Instagram.

Fan of the show? https://www.patreon.com/newleftradio (Support us on Patreon)! Infant food insecurity. In Canada. In 2022. Author and academic, Lesley Frank joins us to discuss her research and book, Out of Milk, Infant Food Insecurity in a Rich Nation. Why is it that the most vulnerable among us go hungry in one of the wealthiest nations in the world? How deep does the problem go? What can be done about it? About Out of Milk: Infant Food Insecurity in a Rich Nation “Did you ever go to bed and wonder if your child was getting enough to eat?” For food insecure mothers, the worry is constant, and babies are at risk of going hungry. Out of Milk calls out the pressing need to establish the economic and social conditions necessary for successful breastfeeding and for accessible, reliable, and safe formula feeding for families everywhere. Through compelling interviews, Lesley Frank answers the breastfeeding paradox: why women who can least afford to buy infant formula are less likely to breastfeed. She reveals that what and how infants are fed is linked to the social and economic status of those who feed them. Out of Milk uncovers the shocking reality of food insecurity for formula-fed babies, the economic and social constraints limiting mothers' ability to breastfeed, and the lengths to which mothers must go to provide for their children. But in a country that leaves the problem of food insecurity to ineffective charity models, public policies are failing to support our most vulnerable populations. This book is important reading for health practitioners, social workers, community agency workers, and policymakers involved with food insecurity, infant feeding, poverty, social welfare, health, or food policy. It is also essential for students and scholars in sociologies of health, food, family; nutrition; food studies; nursing, public/social policy; and women's and gender studies. https://www.ubcpress.ca/out-of-milk (Buy Out of Milk now) About Lesley Frank Lesley Frank is the Canada Research Chair in Food, Health, and Social Justice at Acadia University in Wolfville, Nova Scotia. She is a leading scholar of infant food insecurity in Canada, with publications in the journals Food, Culture and Society; Food and Foodways; Canadian Food Studies; and the Canadian Medical Association Journal. She is the author of the annual Nova Scotia Family and Child Poverty Report Card and a steering member of Campaign 2000, a cross-Canada public education movement that works to increase public awareness of the levels and consequences of child and family poverty. Her work has been featured on CBC's The Current. https://twitter.com/FranklyLess?s=20&t=Npe2iyJQH4UJcqLmZdfOpg (Follow Lesley Frank on Twitter) Stay connected with the latest from New Left Radio by https://newleft.us6.list-manage.com/subscribe?u=8227a4372fe8dc22bdbf0e3db&id=e99d6c70b4 (joining our mailing list) today! _________

In Podcast Episode #1091, Marc Abrahams shows an unfamiliar research study to psycholinguist Jean Berko Gleason. Dramatic readings and reactions ensue. Remember, our Patreon donors, on most levels, get access to each podcast episode before it is made public. Jean Berko Gleason encounters: “Hula-Hoop Syndrome,” Zafar H. Zaidi, Canadian Medical Association Journal, vol. 80, no. 9, May 1, 1959, pp. 715-716. Seth Gliksman, Production Assistant --- Support this podcast: https://anchor.fm/improbableresearch/support

Você acredita que já houve gente que acreditou em criminosos natos? Você sabia que já se tentou regenerar criminosos contumazes por meio de operações plásticas? Ficou curioso? Ouça/veja o episódio. Referências Código Penal Brasileiro. Decreto Lei 2.848 de 7 de dezembro de 1940. LEWISON, Edward. An experiment in facial reconstructive surgery in a prison population. Canadian Medical Association Journal, v. 92, n. 6, p. 251, 1965. LOMBROSO, Cesare. O homem delinquente. Editora Edijur, 2020. PEARL, Sharrona. Change Your Face, Change Your Life? Prison Plastic Surgery as a Way to Reduce Recidivism. Journal of the History of Medicine and Allied Sciences, 2022. THOMPSON, Kevin M. Refacing inmates: A critical appraisal of plastic surgery programs in prison. Criminal Justice and Behavior, v. 17, n. 4, p. 448-466, 1990. --- Send in a voice message: https://anchor.fm/jordanoaraujo/message

In this episode, Amie and Sara talk pain management with the Canadian Medical Association President-Elect Dr. Alika Lafontaine.  We discuss the subjectivity and management of pain in racialized communities and marginalized individuals. We focus on issues related to pain from the perspectives of the care provider and the patient. We also outline practical approaches and tangible solutions on how healthcare providers can improve their assessment, approach and understanding of pain management. This episode is a tool everyone should have in their healthcare toolkit.  Dr. Lafontaine is an award-winning physician who practises anesthesia in Grande Prairie, Alberta. He was born and raised in Treaty 4 Territory (Southern Saskatchewan) and has Anishinaabe, Cree, Metis and Pacific Islander ancestry. Pending confirmation of his nomination by CMA General Council this August, Dr. Lafontaine will serve as president-elect until August 2022, when he will become CMA president.  Dr. Alika Lafontaine is the first Indigenous doctor listed in Medical Post's 50 Most Powerful Doctors. He was born and raised in Treaty 4 Territory (Southern Saskatchewan) and has Anishinaabe, Cree, Metis and Pacific Islander ancestry. He currently lives, works and plays in Treaty 8 Territory in Northern Alberta. Dr. Lafontaine has served in medical leadership positions for almost two decades. Alberta Medical Association: representative forum (since 2012), nominations committee, Indigenous health committee, current board member. Canadian Medical Association: Alberta AGM delegate, appointments committee, Chair governance council Canadian Medical Association Journal. Royal College of Physicians and Surgeons of Canada: Indigenous health advisory committee, search/selection subcommittees, Chair regional advisory committee (western provinces), current council member. HealthCareCAN: current board member. Indigenous Physicians Association of Canada: vice-President and President. Lead and core team member of various Indigenous and non-Indigenous health transformations within Saskatchewan, Alberta and nationally. From 2013-2017 Dr. Lafontaine co-led the Indigenous Health Alliance project, one of the most ambitious health transformation initiatives in Canadian history. Led politically by Indigenous leadership representing more than 150 First Nations across three provinces, the Alliance successfully advocated for $68 million of federal funding towards Indigenous health transformation within Saskatchewan, Manitoba and Ontario. He was recognized for his work in the Alliance by the Public Policy Forum where Prime Minister Justin Trudeau presented the award. Dr. Lafontaine is also a past recipient of the Canadian Medical Association Award for Young Leaders (Early Career) and the Canadian Medical Association Sir Charles Tupper Award for Political Action. He remains the youngest recipient of the Indspire Award, the highest honour the Indigenous community bestows upon its own people. In 2020, Dr. Lafontaine launched the Safespace Networks project with friendship centres across British Columbia. Safespace Networks provides a safe and anonymous workflow to report and identify patterns of care; patients and providers use the platform to share their own experiences and contribute to system change without the risk of retaliation for sharing their truths. It provides a learning system approach for identifying and intervening in issues with patterns of practice anonymously, before they become official concerns or complaints. Dr. Lafontaine continues to practise anesthesia in Grande Prairie, where he has lived with his wife and four children for the last ten years. Twitter @AlikaMD

Hello everyone and welcome to the Mouse Club! This week I am talking all about the different fan theories about Winnie the Pooh characters being representative of different mental health issues and struggles. I researched two primary theories which were from the Canadian Medical Association Journal and from Valentina Stoycheva from Psychology Today and I really enjoyed Valentina's theory that rather than representing different Mental Illnesses, the Winnie the Pooh characters are rather a subconscious method by the author to personify his experiences with Post Traumatic Stress Disorder from World War 1. I hope that you all enjoy and let me know what you think about these theories as well! Check us out on Instagram: Instagram.com/themouseclubpodcast About the Host: Instagram: Instagram.com/littlemrsmariss YouTube : https://www.youtube.com/channel/UCQED9xEETLe_FCkW3ZosxZA --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app

Dr. Karen Bosma, London Health Sciences Centre and lead author of the report published in the Canadian Medical Association Journal talks about first case of near-fatal vaping related injury in Canada

Could cancer be a contagious disease? Although this possibility might seem surprising to many of us, it has a long history. In fact, efforts to develop a cancer vaccine drew more money than the Human Genome Project. In his first book, MIT historian of science Robin Wolfe Scheffler takes readers through the twists and turns of the American effort to identify human cancer viruses— a search which made fundamental contributions to molecular biology. In this podcast, we discuss how this was an effort which raises fundamental questions regarding how we think about disease in the laboratory and the legislature. Dr. Robin Scheffler's book is called A Contagious Cause: The American Hunt for Cancer Viruses and the Rise of Molecular Medicine(University of Chicago Press, 2019). Dr. Dorian Deshauer is a psychiatrist, historian, and assistant professor at the University of Toronto. He is associate editor for the Canadian Medical Association Journal, Canada's leading peer-reviewed general medical journal and is one of the hosts of CMAJ Podcasts, a medical podcast for doctors and researchers. Learn more about your ad choices. Visit megaphone.fm/adchoices

Could cancer be a contagious disease? Although this possibility might seem surprising to many of us, it has a long history. In fact, efforts to develop a cancer vaccine drew more money than the Human Genome Project. In his first book, MIT historian of science Robin Wolfe Scheffler takes readers through the twists and turns of the American effort to identify human cancer viruses— a search which made fundamental contributions to molecular biology. In this podcast, we discuss how this was an effort which raises fundamental questions regarding how we think about disease in the laboratory and the legislature. Dr. Robin Scheffler's book is called A Contagious Cause: The American Hunt for Cancer Viruses and the Rise of Molecular Medicine(University of Chicago Press, 2019). Dr. Dorian Deshauer is a psychiatrist, historian, and assistant professor at the University of Toronto. He is associate editor for the Canadian Medical Association Journal, Canada's leading peer-reviewed general medical journal and is one of the hosts of CMAJ Podcasts, a medical podcast for doctors and researchers. Learn more about your ad choices. Visit megaphone.fm/adchoices

Traditionally we've run at least 2 troponins 6 or 8 hours apart to help rule out MI and recently in algorithms like the HEART score we've combined clinical data with a 2 or 3 hour delta troponin to help rule out MI. The paper we'll be discussing here is a multicentre/multinantional study from the Canadian Medical Association Journal from this year out of Switzerland entitled "Prospective validation of a 1 hour algorithm to rule out and rule in acute myocardial infarction using a high sensitivity cardian troponin T assay" with lead author Tobias Reichlin. It not only looks at whether or not we can rule out MI using a delta troponin at only 1 hour but whether or not we can expedite the ruling in of MI using this protocol. The post Journal Jam 5 One Hour Troponin to Rule Out and In MI appeared first on Emergency Medicine Cases.